May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Rituximab (RTX) Treatment for Necrotizing Scleritis in Wegener Granulomatosis Patients
Author Affiliations & Notes
  • C. Recillas-Gispert
    INCMNSZ, Mexico City, Mexico
    Ophthalmology,
  • L. Flores-Suarez
    INCMNSZ, Mexico City, Mexico
    Rheumatology,
  • Footnotes
    Commercial Relationships  C. Recillas-Gispert, None; L. Flores-Suarez, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 4726. doi:https://doi.org/
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    • Get Citation

      C. Recillas-Gispert, L. Flores-Suarez; Rituximab (RTX) Treatment for Necrotizing Scleritis in Wegener Granulomatosis Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4726. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To evaluate clinical response to Rituximab (RTX) in 4 refractory patients with necrotizing scleritis secondary to Wegener granulomatosis.

Methods: : We studied 4 patients with Wegener granulomatosis acording to the Chapel Hill criteria and severe necrotizing scleritis unresponsive to steroids and immunesupressors treated with RTX one gram twice, two-weeks apart. We evaluated clinical response, lymphocyte subsets and anti-neutrophil citoplasm antibody.

Results: : Case1: A 51 years old male with refractory necrotizing scleritis who received 103gr cumulative cyclophosphamide (CYC). Azathioprine (AZA) was not tolerated and prednisone (PDN) remained >30mg qd.Case 2: A 36 years old female with rhinosinusitis and necrotizing scleritis with peripheral ulcerative keratitis. She had received high-dose PDN, CYC (120gr), methotrexate (MTX) and AZA. In spite of PDN 60mg qd she had active sinusitis and corneal perforation.Case 3: A 56 years old female with severe necrotizing scleritis. After years, PDN remained >30mg qd, had severe Cushing and did not respond to MTX or CYC. A refractory panuveitis developed.Case 4: A 28 years old male with progressive and severe peripheral ulcerative keratitis with perforation associated to necrotizing scleritis, rhinosinusitis and pulmonary afection despite high-dose PDN and CYC.Evolution: RTX was well tolerated in all cases, There was an immediate lymphocyte depletion without concomitant infections. Clinical improvement was seen in the first 4 weeks without progresion of ocular melting process. At 8 months all patients were of other immunesupressors.

Conclusions: : MTX is useful for the treatment for refractory necrotizing scleritis in patients with Wegener granulomatosis

Keywords: sclera • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • keratitis 
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