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Juan Carlos Serna-Ojeda, Claudia Recillas-Gispert, Luis Flores-Suarez; Rituximab in the treatment of refractory scleritis in patients with granulomatosis with polyangiitis (Wegener’s granulomatosis): The Mexican experience. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2542.
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The purpose of the study is to evaluate the clinical response to rituximab in patients with scleritis due to granulomatosis with polyangiitis (GPA) refractory to treatment with steroids and immunosuppressive agents, mainly cyclophosphamide and methotrexate.
We performed a retrospective chart review of all the patients with scleritis secondary to GPA that were refractory to conventional treatment and that received rituximab as therapy for remission induction. Rituximab was administered using 2 doses of 1 gram, 15 days apart. Patient follow-up was clinical (systemic and ophthalmologic) and paraclinical with serial ANCA determinations plus B-cell CD19+ and CD20+ measurements.
We included 7 patients with 11 affected eyes. Main indication was refractory necrotizing anterior scleritis.. Four weeks after finishing the treatment with rituximab, all patients showed evident clinical improvement without further progression of destructive process. Six patients (85.7%) achieved ocular remission in 7 months or less. All had CD19+ and CD20+ depletion and lowered ANCA levels. However, three patients presented ocular relapses, which consisted in reactivation of the anterior scleritis, uveitis and posterior scleritis, and two required a second dose of rituximab with immediate improvement.
Rituximab is useful in the treatment of refractory necrotizing scleritis in patients with GPA even in cases where the scleritis is due a component of granulomatous inflammation.
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