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Gupta Y, Kishore A, Kumari P, Balakrishnan N, Lomi N, Gupta N, Vanathi M, Tandon R. Peripheral ulcerative keratitis. Surv Ophthalmol 2021; 66:977-998. [PMID: 33657431 DOI: 10.1016/j.survophthal.2021.02.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Peripheral ulcerative keratitis (PUK) is an inflammatory condition of the peripheral cornea with hallmark features of epithelial defects and stromal destruction as a result of a complex interplay of factors including host autoimmunity and the peculiar anatomic and physiologic features of the peripheral cornea and environmental factors. PUK may be the result of local or systemic causes and infectious or noninfectious causes. Arriving at a specific etiological diagnosis requires a meticulous clinical workup that may include a battery of laboratory and radiological investigations. Management by a team of internists or rheumatologists and ophthalmologists and judicious use of immunosuppressive agents may yield favorable results minimizing adverse effects. We review current clinical knowledge on the diagnosis and management of PUK.
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Affiliation(s)
- Yogita Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Alisha Kishore
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Kumari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neelima Balakrishnan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neiwete Lomi
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - M Vanathi
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India;.
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Aaltonen V, Alavesa M, Pirilä L, Vesti E, Al-Juhaish M. Case report: bilateral Mooren ulcer in association with hepatitis C. BMC Ophthalmol 2017; 17:239. [PMID: 29212473 PMCID: PMC5719567 DOI: 10.1186/s12886-017-0633-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mooren ulcer has been considered as an idiopathic autoimmune keratitis. However, it has been in some cases suggested to be associated with hepatitis C, although the evidence is very vague. CASE PRESENTATION We present a case of a man who was diagnosed with a primary Mooren ulcer in his right eye. The eye became blind despite of intensive treatment with local medications and extensive surgical procedures. After 10 years, the patient was diagnosed with the same disease, now in his left, previously healthy eye. There was no history that would suggest a secondary Mooren ulcer, but a chronic hepatitis C infection was detected. Treatment was targeted against hepatitis C (ribavirin and interferon) in addition to immunosuppressive medical and surgical treatment which resulted in a full and more than 6 years lasting remission of the disease. CONCLUSIONS Whether the immunomodulatory and immunosuppressive medication against hepatitis C was the key reason for the good results in the treatment of the second eye, remains elusive. The causality of hepatitis C with respect to the pathogenesis of Mooren ulcer on this patient remains open, but should be considered as one of the possible etiological factors of the disease.
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Affiliation(s)
- Vesa Aaltonen
- Department of Ophthalmology, Turku University Hospital, PO Box 52, FIN-20521, Turku, Finland. .,Department of Ophthalmology, University of Turku, FIN-20014, Turku, Finland.
| | - Mari Alavesa
- Department of Ophthalmology, Turku University Hospital, PO Box 52, FIN-20521, Turku, Finland
| | - Laura Pirilä
- Department of Rheumatology, Division of Medicine, Turku University Hospital, Box 52, FIN-20521, Turku, PO, Finland.,Department of Internal Medicine, University of Turku, FIN-20014, Turku, Finland
| | - Eija Vesti
- Department of Ophthalmology, Turku University Hospital, PO Box 52, FIN-20521, Turku, Finland.,Department of Ophthalmology, University of Turku, FIN-20014, Turku, Finland
| | - Mohammad Al-Juhaish
- Department of Ophthalmology, Turku University Hospital, PO Box 52, FIN-20521, Turku, Finland
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Ocular surface and tear parameters in patients with chronic hepatitis C at initial stages of hepatic fibrosis. Eye Contact Lens 2015; 41:117-20. [PMID: 25503914 DOI: 10.1097/icl.0000000000000079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate changes in ocular surface and tear function parameters in chronic hepatitis C at initial stages of hepatic fibrosis. METHODS Thirty-one patients with biopsy-proven chronic hepatitis C and 31 age- and sex-matched healthy control subjects without systemic hepatitis C infection were examined with the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I, tear film break-up time, and scoring of ocular surface fluorescein and Rose Bengal staining using modified Oxford and van Bijsterveld scoring systems, respectively. RESULTS All ocular surface parameters, except OSDI and corneal staining scores, were significantly worse in hepatitis C group. The control group had greater OSDI scores than the hepatitis C group, but there was no statistically important difference. In subgroup analysis, progression of hepatic fibrosis was found to be correlated strongly with decreased Schirmer test I, increased OSDI, lid parallel conjunctival folds, conjunctival, and corneal staining scores. CONCLUSION Patients with chronic hepatitis C were more likely to exhibit severe ocular surface damage and signs of dry eye.
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Abstract
BACKGROUND Mooren's ulcer is a chronic, painful peripheral ulcer of the cornea. Its cause is unknown but it can or will lead to loss of vision if untreated. Severe pain is common in patients with Mooren's ulcer and the eye(s) may be intensely reddened, inflamed and photophobic, with tearing. The disease is rare in the northern hemisphere but more common in southern and central Africa, China and the Indian subcontinent. There are a number of treatments used such as anti-inflammatory drugs (steroidal and non-steroidal), cytotoxic drugs (topical and systemic), conjunctivectomy and cornea debridement (superficial keratectomy). There is no evidence to show which is the most effective amongst these treatment modalities. OBJECTIVES The aim of this systematic review is to assess the effectiveness of the various interventions (medical and surgical) for Mooren's ulcer. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 June 2013. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) or discuss any prospective non-RCTs in the absence of any RCTs. The trials included would be of people of any age or gender diagnosed with Mooren's ulcer and all interventions (medical and surgical) would be considered. DATA COLLECTION AND ANALYSIS Two authors screened the search results independently; we found no studies that met our inclusion criteria. MAIN RESULTS As we found no studies that met our inclusion criteria, we highlighted important considerations for conducting RCTs in the future in this area. AUTHORS' CONCLUSIONS We found no evidence in the form of RCTs to assess the treatment effect for the various interventions for Mooren's ulcer. High quality RCTs that compare medical or surgical interventions across different demographics are needed. Such studies should make use of various outcome measures, (i.e. healed versus not healed, percentage of area healed, speed of healing etc.) as well as ensuring high quality randomisation and data analysis, as highlighted in this review .
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Affiliation(s)
- Mahmoud B Alhassan
- Clinical Ophthalmology, The National Eye Centre, Western Bye Pass, Nnamdi Azikiwe Way, Kaduna, Kaduna State, Nigeria, PMP 2267
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Meskin SW, Carlson EM. Mooren’s-type Ulceration Associated with Severe Hidradenitis Suppurativa: A Case Report and Literature Review. Ocul Immunol Inflamm 2011; 19:340-2. [DOI: 10.3109/09273948.2011.584653] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Mooren's ulcer is a chronic, painful peripheral ulcer of the cornea. Its cause is unknown but it can or will lead to loss of vision if untreated. Severe pain is common in patients with Mooren's ulcer and the eye(s) may be intensely reddened, inflamed and photophobic, with tearing. The disease is rare in the northern hemisphere but more common in southern and central Africa, China and the Indian subcontinent. There are a number of treatments used such as anti-inflammatory drugs (steroidal and non-steroidal), cytotoxic drugs (topical and systemic), conjunctivectomy and cornea debridement (superficial keratectomy). There is no evidence to show which is the most effective amongst these treatment modalities. OBJECTIVES The aim of this systematic review is to assess the effectiveness of the various interventions (medical and surgical) for Mooren's ulcer. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 4), MEDLINE (January 1950 to April 2011), EMBASE (January 1980 to April 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS), (January 1982 to April 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrial.gov). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 16 April 2011. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) or discuss any prospective non-RCTs in the absence of any RCTs. The trials included would be of people of any age or gender diagnosed with Mooren's ulcer and all interventions (medical and surgical) would be considered. DATA COLLECTION AND ANALYSIS Two authors screened the search results independently; we found no studies that met our inclusion criteria. MAIN RESULTS As we found no studies that met our inclusion criteria, we highlighted important considerations for conducting RCTs in the future in this area. AUTHORS' CONCLUSIONS We found no evidence in the form of RCTs to assess the treatment effect for the various interventions for Mooren's ulcer. High quality RCTs that compare medical or surgical interventions across different demographics are needed. Such studies should make use of various outcome measures, (i.e. healed versus not healed, percentage of area healed, speed of healing etc.) as well as ensuring high quality randomisation and data analysis, as highlighted in this review .
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Affiliation(s)
- Mahmoud B Alhassan
- Clinical Ophthalmology, The National Eye Centre, Western Bye Pass, Nnamdi Azikiwe Way, Kaduna, Kaduna State, Nigeria, PMP 2267
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Biber JM, Schwam BL, Raizman MB. Scleritis. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Böckle BC, Sepp NT. Hepatitis C virus and autoimmunity. AUTO- IMMUNITY HIGHLIGHTS 2010; 1:23-35. [PMID: 26000104 PMCID: PMC4389064 DOI: 10.1007/s13317-010-0005-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 03/04/2010] [Indexed: 12/12/2022]
Abstract
Hepatitis C virus infection is associated with several extrahepatic manifestations. About 60% of patients infected with HCV develop at least one extrahepatic manifestation. The majority of these diseases seem to be triggered through autoimmune mechanisms, such as autoantibody production, autoreactive T cells and complex autoimmune mechanisms leading to systemic autoimmune disorders. In this review we categorize these diseases into three groups according to the main pathogenetic process involved, in particular B-cell-mediated, T-cell-mediated and complex autoimmune systemic diseases.
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Affiliation(s)
- Barbara C. Böckle
- Department of Dermatology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Norbert T. Sepp
- Department of Dermatology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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Bouchard CS. Noninfectious Keratitis. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Okuse C, Yotsuyanagi H, Koike K. Hepatitis C as a systemic disease: virus and host immunologic responses underlie hepatic and extrahepatic manifestations. J Gastroenterol 2007; 42:857-65. [PMID: 18008029 DOI: 10.1007/s00535-007-2097-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 07/24/2007] [Indexed: 02/04/2023]
Affiliation(s)
- Chiaki Okuse
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University, Kawasaki, Japan
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Jacobi C, Wenkel H, Jacobi A, Korn K, Cursiefen C, Kruse FE. Hepatitis C and ocular surface disease. Am J Ophthalmol 2007; 144:705-711. [PMID: 17870047 DOI: 10.1016/j.ajo.2007.07.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 07/21/2007] [Accepted: 07/23/2007] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the frequency of changes in the ocular surface and the presence of hepatitis C virus (HCV) in tear samples of patients with chronic HCV infection. DESIGN Prospective, nonrandomized, clinical, interdisciplinary, single-center study. METHODS Seventy-one patients with previously untreated chronic HCV infection and a control group consisting of 66 patients without systemic HCV infection were enrolled in the trial. The patients with HCV infection were screened for ocular symptoms, visual acuity, and ocular changes. Tear production was measured by the Jones test. Conjunctival impression cytologic analysis was performed. The presence of HCV ribonucleic acid (RNA) in tear and blood samples was determined by quantitative polymerase chain reaction. RESULTS On examination, systemic HCV infection was present for a median of 30 months. Fifty percent of all HCV patients showed a decrease in tear production measured by the Jones test. Apart from epithelial changes related to dry eye syndrome in 12 patients, two patients presented mild peripheral corneal thinning. Polymerase chain reaction analysis detected HCV RNA in five (10%) of 52 tear samples. HCV RNA levels in tear samples (mean, 1.0 x 10(4) copies/ml) were considerably lower than in blood samples (mean, 5.3 x 10(5) copies/ml). CONCLUSIONS Dry eye syndrome is the most frequently observed ocular feature in HCV infection. Patients with HCV infection (age range, 21 to 60 years) compared with the controls had a significant lower tear production (P = .05). The presence of HCV RNA in 10% of tear samples emphasizes the potential risk of viral transmission through tears.
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Affiliation(s)
- Christina Jacobi
- Department of Ophthalmology, University of Erlangen, Erlangen, Germany.
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Wang QS, Yuan J, Zhou SY, Chen JQ. Chronic hepatitis C virus infection is not associated with Mooren's ulcer. Eye (Lond) 2007; 22:697-700. [PMID: 17618247 DOI: 10.1038/sj.eye.6702788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To investigate the association between chronic hepatitis C virus (HCV) infection and Mooren's ulcer. METHODS Eight patients from different parts of China who were diagnosed with Mooren's ulcer at the Zhongshan Ophthalmic Center, Guangzhou (China) were screened for chronic HCV infection. Mooren's ulcer was diagnosed by the typical ulcer morphology, detailed case history, physical examination, and comprehensive laboratory tests. All patients had serological screening for HCV infection. RESULTS Six male and two female patients were enrolled in the study. Their ages ranged from 31 to 65 years (mean 43.6+/-13.7). None of them was reported to have any clinical evidence of chronic HCV infection before enrolment and all were negative for HCV serology. CONCLUSION There was no association between chronic HCV infection and Mooren's ulcer in this limited case series study.
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Affiliation(s)
- Q-S Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Rabiu M, Alhassan MB, Agbabiaka IO. Interventions for Mooren's ulcer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd006131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
AIM To study the association between chronic hepatitis C virus (HCV) and Mooren's type keratitis. METHOD A total of 50 patients with chronic HCV were screened for any evidence of corneal ulceration. Detailed ocular examination was conducted by slit-lamp biomicroscopy. Patients with history of trauma to the eye or previous herpetic keratitis were excluded from the study. RESULTS There were 37 males and 13 females. The age of the patients ranged from 10 to 70 years. There was no evidence of Mooren's ulcer in any of our patients. CONCLUSION No association between chronic HCV and Mooren's ulcer was found in our study. Screening therefore in such cases is not necessary.
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Affiliation(s)
- A K Jain
- Cornea and External Diseases Section, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Abstract
This article reviews disorders in which both gastrointestinal and ocular disease can occur. Gastrointestinal disease can affect the eye as part of the disease spectrum, and in other instances both the gastrointestinal system and the eye may be involved as part of a systemic disease process. The gastrointestinal system may be adversely affected by the treatment of an unrelated eye disease. Also, certain infections of the gastrointestinal system can have an adverse effect on the eye.
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Affiliation(s)
- Aldrin Khan
- Department of Clinical Ophthalmology, Institute of Ophthalmology, Moorfields Eye Hospital, London EC1V 2PD
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Abstract
Hepatitis C virus (HCV) affects 1.8% of the American population, and approximately 38% of patients with HCV will manifest symptoms of at least 1 extrahepatic manifestation during the illness. Renal disease, neuropathy, lymphoma, and Sjögren syndrome with or without mixed cryoglobulinemia are all strongly associated with HCV infection. Porphyria cutanea tarda and diabetes have also been linked to HCV. Most extrahepatic manifestations of chronic HCV infection are immunological, and the chronic infection seems to be necessary for their development. The molecular study of the unique way in which the HCV virus interacts with the human immune system is beginning to provide plausible explanations of the pathogenic role of HCV in some of these syndromes, but many pathogenetic links remain completely obscure.
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Affiliation(s)
- Marlyn J Mayo
- Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medial Center at Dallas, Dallas, Texas 75390-9151, USA.
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[Severe Moorens ulcer: efficacy of monthly cyclophosphamide intravenous pulse treatment]. Rev Med Interne 2003; 24:118-22. [PMID: 12650893 DOI: 10.1016/s0248-8663(02)00021-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Mooren's ulcer (MU) is a chronic peripheral corneal ulceration featuring conjunctival immunoglobulin deposits. It is considered as the result of a limbic immune process with hyperactivation of T and B lymphocytes. The etiology remains unknown. The response to topical steroid therapy and surgical procedures usually poor and the visual outcome can be devastating. METHODS Clinical follow-up of 3 patients who had rebel MU to conventional therapy, and were treated with 1g monthly intravenous cyclophosphamide. RESULTS First patient was a 24-years-old man who had MU in his left eye. The response to surgical procedure and intravenous steroid treatment was poor and corneal perforation occurred. The affected cornea healed after 9 months of Cy treatment. The second patient was a 50-years-old man who had MU in his left eye, which did not improved with lamellar keratoplasty and topical steroid therapy. Corneal healing was obtained after 20 months of Cy treatment. The third patient was a 70-years-old man who presented with a furrowed MU in his right eye which healed with conjunctival resection and 4 months of Cy perfusion. No adverse effects of Cy was noted as opposed to Cy given orally. CONCLUSION We report the effectiveness of 1g monthly intravenous cyclophosphamide (Cy) treatment in rebel MU. We suggest that immunosuppressive therapy using IV monthly Cy may be proposed in severe rebel MU.
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Zegans ME, Anninger W, Chapman C, Gordon SR. Ocular manifestations of hepatitis C virus infection. Curr Opin Ophthalmol 2002; 13:423-7. [PMID: 12441848 DOI: 10.1097/00055735-200212000-00014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Approximately 3.6 million persons in the United States are infected with the hepatitis C virus (HCV), a condition with both hepatic and extrahepatic sequelae. Although no pathognomonic manifestation of HCV infection in the eye has been demonstrated, associations between HCV infection and various ocular syndromes have been reported in small case series and individual patients. At this time, the ocular manifestations of HCV infections best supported by the literature include a dry eye syndrome similar to Sjögren syndrome, and ischemic retinopathy caused by either an HCV-induced vasculitis or treatment with interferon. Patients with diabetes seem to be more susceptible to interferon retinopathy and to subsequent permanent visual loss. There have been no cases of HCV transmission via corneal transplantation, suggesting that current cadaveric screening protocols are effective in preventing this route of transmission. Screening for HCV should be considered in patients with risk factors for HCV infection who suffer from unexplained ischemic retinopathy or dry eyes.
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Affiliation(s)
- Michael E Zegans
- Dartmouth Medical School, Section of Ophthalmology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Yoshida K, Nakano H, Yoshitomi F, Oshika T. Prevalence of seropositivity for hepatitis C virus in cataract patients and the general population. J Cataract Refract Surg 2002; 28:1789-92. [PMID: 12388029 DOI: 10.1016/s0886-3350(02)01335-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the epidemiologic relationship between hepatitis C virus (HCV) infection and cataract. SETTING Yoshida Eye Clinic, Fukuoka, Japan. METHODS This study included 492 patients with age-related cataract and 2624 controls who had a municipal mass health screening. All subjects were 60 years or older and inhabitants of Chikugo City (population 45000), Fukuoka, Japan. Each subject was serologically tested for HCV using the third-generation enzyme immunoassay. Seropositivity was compared in subgroups consisting of patients by decade; that is 60 to 69 years of age, 70 to 79 years of age, and 80 to 90 years of age. RESULTS The prevalence of HCV in the cataract group and health-screening (control) group was 18.3% and 7.1%, respectively, in the 60- to -69 year subgroup; 17.8% and 6.6%, respectively, in the 70- to 79-year subgroup; and 15.1% and 3.7%, respectively, in the 80- to 90-year subgroup. In each subgroup, the prevalence of HCV was significantly higher in the cataract group than in the control group (P <.01, chi-square test). In the cataract group, the HCV seropositive and seronegative groups did not differ significantly in the prevalence of hepatitis B virus (P =.548, Fisher exact probability test). CONCLUSIONS Patients with age-related cataract had significantly higher seropositivity for HCV than an age-matched general population. This suggests that HCV infection may play a role in the development and/or progression of cataract.
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Affiliation(s)
- Koichi Yoshida
- Yoshida Eye Clinic, Yoshitomi Eye Center, Fukuoka, Japan
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Pluznik D, Butrus SI. Hepatitis C-associated peripheral corneal ulceration: rapid response to intravenous steroids. Cornea 2001; 20:888-9. [PMID: 11685073 DOI: 10.1097/00003226-200111000-00023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We present a case of peripheral corneal ulceration in a patient with hepatitis C, which rapidly and dramatically responded to intravenous steroid treatment. METHODS Clinical examination and photographs were obtained to document initial presentation and therapeutic response of Mooren's-type ulcers to steroids. RESULTS Bilateral peripheral corneal ulceration with documented progression responded to intravenous administration of steroids within 5 days. CONCLUSION Previous reports of Mooren's-type ulcers in patients with chronic hepatitis C have shown a response to interferon alfa-2b, but not to oral corticosteroid therapy. Given the medical contraindications to interferon use in selected patients and the cost, we suggest a trial of high-dose systemic steroids as a possible therapy.
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Affiliation(s)
- D Pluznik
- Washington National Eye Center, Washington Hospital Center, Department of Ophthalmology, Washington, DC, USA.
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Abstract
Background: In recent years, it has been suggested that oral lichen planus (OLP), a chronic inflammatory keratotic lesion, is related to hepatitis C virus (HCV) infection. Therefore, we evaluated whether the presence or absence of HCV infection caused any histopathological differences in OLP tissues. Methods; The subjects consisted of 31 patients with HCV-related liver disease complicated by OLP (32 OLP lesions) and ten OLP patients without complications due to either HCV infection or liver disease (control). A histopathological evaluation was performed in these patients. In addition, immunostaining was done on nine OLP tissues infected with HCV and on six OLP tissues without HCV infection in order to evaluate lymphocyte subsets (T cells or B cells) infiltrating into topical regions with OLP. Furthermore, the severity of hepatic fibrosis and inflammation was evaluated in liver tissues obtained by liver biopsy from six patients with HCV-related liver disease to evaluate whether there were any relationships between the severity of hepatic fibrosis or inflammation and OLP tissues. Results: There were no significant differences in the histopathological characteristics specific to OLP or in the ratios of T and B cells among infiltrating lymphocytes regardless of the presence or absence of HCV infection. Moreover, there were no certain relationships between the severity of hepatic fibrosis or inflammation and the severity of lymphocytic infiltration in OLP. Conclusions: HCV infection does not appear to influence the histopathological and immunohistochemical features of OLP.
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Affiliation(s)
- A L Zignego
- Department of Internal Medicine, University of Florence, Italy.
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Abe T, Nakajima A, Matsunaga M, Sakuragi S, Komatsu M. Decreased tear lactoferrin concentration in patients with chronic hepatitis C. Br J Ophthalmol 1999; 83:684-7. [PMID: 10340976 PMCID: PMC1723068 DOI: 10.1136/bjo.83.6.684] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Decreased tear volume in patients with chronic hepatitis C has been reported in the literature. Lactoferrin is abundantly present in human tears, the main source of which is the acini of the lacrimal glands. In this study tear lactoferrin levels were measured to investigate the dry eye condition of patients with chronic hepatitis C. METHODS Lactoferrin in tears/fluid was measured by a radial immunodiffusion assay in 42 patients with chronic hepatitis C. The rate of lacrimal secretion was determined by the cotton thread test. Rose bengal staining of the ocular surface was also performed. RESULTS Only three patients out of 42 complained of dry eye sensation and, in 31 patients, six showed positive results on the rose bengal staining test of the ocular surface. The lactoferrin concentration of tear fluid in the chronic hepatitis C group (1.42 (SD 0.56) mg/ml) was significantly lower than in the control group (1.90 (0.62) mg/ml; p <0.00048). The cotton thread test results in the chronic hepatitis C group (12.9 (5. 5) mm) were significantly lower than in the control group (17.9 (5. 3) mm; p<0.00048). Also, in the chronic hepatitis C group, tear lactoferrin concentration correlated with the results of the cotton thread test (r = 0.35, p<0.05). CONCLUSION Chronic hepatitis C patients showed both decreased tear volume, and decreased tear lactoferrin concentration. These findings suggest that there may be dysfunction of the lacrimal glands in patients with chronic hepatitis C, which may account for the mild dry eye.
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Affiliation(s)
- T Abe
- Department of Ophthalmology, Akita University School of Medicine, Akita City, Japan
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