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A.M. Bauer, C. Fiehn, M.D. Becker; Selective Inhibitors of Cyclooxygenase 2 for Therapy of Diffuse Anterior Scleritis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):684.
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Purpose: Scleritis is a painful inflammation of the sclera that is often quite difficult to treat. Oral non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to be effective. If they are not effective, corticosteroids or other systemic immunosuppressive agents are recommended. NSAIDs inhibit both isoenzymes of cyclooxygenase (COX): inhibition of COX-2 is responsible for the anti-inflammatory effects, while inhibition of COX-1 leads to gastrointestinal side effects. Consequently, celecoxib, a COX-2 inhibitor, is an anti-inflammatory drug with minimal gastrointestinal side effects. Results of treating 16 cases of diffuse anterior scleritis with celecoxib are reported. Methods: Sixteen patients suffering from diffuse anterior scleritis were seen in the Interdisciplinary Uveitis Center in Heidelberg, between April 2001 and November 2002. All patients presented with painful redness of the sclera. All patients were treated with a 300 to 800 mg of celecoxib per day, in divided doses, depending on degree of discomfort and clinical severity. Results: All 16 patients experienced significant clinical improvement within 5 days, on average, of commencing celecoxib. All patients reported a complete loss of pain and scleral redness. Fifteen patients experienced complete symptomatic remission, so that the dose of Celecoxib was tapered. Two of these patients suffered from a second attack of scleritis, and these patients required long-term low-dose therapy. Treatment with celecoxib was associated with no side effects apart from an allergic exanthema suffered by one patient, which responded to cessation of the drug. No patients needed additional treatment with oral corticosteroids or other immunosuppressive drugs. Conclusions: Due to its anti-inflammatory potency and low rate of side effects celecoxib is an effective drug for the treatment of diffuse anterior scleritis. Compared to other NSAID it shows minimal GIT side effects, so that its high costs are justified. It represents an alternative drug to be considered before systemic immunosuppressive treatment.
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