Therapy of scleritis with cytotoxic agents

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Severe anterior scleritis can be refractory to conventional treatments.
• Systemic autoimmune diseases like Wegener's granulomatosis, pyoderma gangrenosum, and rheumatoid vasculitis can manifest with scleritis.

Observation:

• Four patients with severe, treatment-resistant anterior scleritis were identified.
• These patients had underlying autoimmune conditions including Wegener's granulomatosis, pyoderma gangrenosum, and rheumatoid vasculitis.

Findings:

• Patients received cytotoxic immunosuppressive alkylating agents, with or without prednisone.
• All patients demonstrated a positive response, characterized by reduced ocular inflammation and scleral healing.
• Systemic symptoms associated with their underlying autoimmune diseases also frequently improved.

Implications:

• Cytotoxic alkylating agents represent a viable therapeutic option for refractory scleritis.
• This treatment may offer benefits beyond ocular inflammation, addressing systemic autoimmune disease manifestations.
• Further research into alkylating agent therapy for severe scleritis is warranted.