Ocular complications and mortality in peripheral ulcerative keratitis and necrotising scleritis: The role of systemic immunosuppression.
corneal thinning
immunosuppression
inflammation
sclera
ulcerative keratitis
Journal
Clinical & experimental ophthalmology
ISSN: 1442-9071
Titre abrégé: Clin Exp Ophthalmol
Pays: Australia
ID NLM: 100896531
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
16
06
2019
revised:
28
11
2019
accepted:
15
12
2019
pubmed:
25
12
2019
medline:
1
9
2021
entrez:
25
12
2019
Statut:
ppublish
Résumé
Inflammatory ocular diseases are associated with systemic disease, ocular morbidity and mortality. To examine clinical characteristics of subjects with peripheral ulcerative keratitis (PUK) and necrotising scleritis. Retrospective case series in a single tertiary centre over 10 years. All patients presenting with necrotising scleritis, PUK or scleritis with corneal infiltrates. Fifty-two eyes (41 subjects) were identified. Demographic and clinical data analysis. Visual loss, ocular complications and mortality. Mean follow up was 7.0 ± 5.3 years, presentation age 51.3 ± 18.6 years, and 23 subjects (56.1%) were female. Overall, 27 eyes presented with PUK, 26 with necrotising scleritis, and 22 with corneal infiltrates associated with active scleritis. Associated systemic diagnosis was observed in 12 subjects at presentation, and in 21 subjects (51.2%) by final follow up. Recurrence occurred in 23 eyes (44.2%): 10 eyes experiencing PUK or necrotising scleritis; 13 eyes with non-necrotising scleritis. Perforation occurred in six eyes (11.5%). Moderate vision loss occurred in 10 eyes (19.2%) and severe loss in six eyes (11.5%). Five subjects (12.2%) were deceased by study conclusion, of whom four were not on immunomodulatory therapy (IMT). A marked difference in estimated survival was observed with IMT, with mean estimated survival of 10.7 years without treatment, compared to 24.7 years with IMT (P = .045). PUK and necrotising scleritis represent a severe inflammatory disease with high rates of perforation, visual loss and mortality. IMT was associated with a lower rate of mortality and longer estimated survival in this group.
Sections du résumé
IMPORTANCE
Inflammatory ocular diseases are associated with systemic disease, ocular morbidity and mortality.
BACKGROUND
To examine clinical characteristics of subjects with peripheral ulcerative keratitis (PUK) and necrotising scleritis.
DESIGN
Retrospective case series in a single tertiary centre over 10 years.
PARTICIPANTS
All patients presenting with necrotising scleritis, PUK or scleritis with corneal infiltrates. Fifty-two eyes (41 subjects) were identified.
METHODS
Demographic and clinical data analysis.
MAIN OUTCOME MEASURES
Visual loss, ocular complications and mortality.
RESULTS
Mean follow up was 7.0 ± 5.3 years, presentation age 51.3 ± 18.6 years, and 23 subjects (56.1%) were female. Overall, 27 eyes presented with PUK, 26 with necrotising scleritis, and 22 with corneal infiltrates associated with active scleritis. Associated systemic diagnosis was observed in 12 subjects at presentation, and in 21 subjects (51.2%) by final follow up. Recurrence occurred in 23 eyes (44.2%): 10 eyes experiencing PUK or necrotising scleritis; 13 eyes with non-necrotising scleritis. Perforation occurred in six eyes (11.5%). Moderate vision loss occurred in 10 eyes (19.2%) and severe loss in six eyes (11.5%). Five subjects (12.2%) were deceased by study conclusion, of whom four were not on immunomodulatory therapy (IMT). A marked difference in estimated survival was observed with IMT, with mean estimated survival of 10.7 years without treatment, compared to 24.7 years with IMT (P = .045).
CONCLUSIONS AND RELEVANCE
PUK and necrotising scleritis represent a severe inflammatory disease with high rates of perforation, visual loss and mortality. IMT was associated with a lower rate of mortality and longer estimated survival in this group.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
434-441Informations de copyright
© 2019 Royal Australian and New Zealand College of Ophthalmologists.
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