LAUSR

Background Some types of ocular surface inflammatory diseases are often related to rheumatic conditions: 37% of scleritis (especially diffuse and necrotizing forms) and 60% of peripheral ulcerative keratitis (PUK). Rheumatoid arthritis (RA) and ANCA-associated vasculitis are the most frequently related conditions. Significant loss of visual acuity can be observed if these ocular diseases are not properly treated. To date, no approved therapies are available. Consequently, the management of these ocular diseases are based on published evidence coming from clinical trials (scarce and often with a low sample size), observational studies and case reports. There are positive efficacy data of rituximab (RTX) for ocular surface inflammatory disease.1–4 Objectives To describe our experience with RTX as a therapy for severe ocular surface inflammatory diseases associated to rheumatic conditions. Methods This is a retrospective observational study. It includes patients with severe scleritis or PUK associated to rheumatic diseases diagnosed and managed at our Multidisciplinary Uveitis Clinic between January 2006 and November 2017. We recorded demographic and clinical variables. As outcome variables we used the change in visual acuity and the presence of inflammatory activity by biomicroscopy. Results VA: visual acuity, AE: advers events, RA: rheumatoid arthritis, GPA: granulomatosis with polyangiitis, RP: relapsing polychondritis, LTI: latent tuberculous infection, DM: diabetes mellitus, CSC: central serous choroidopathy, MPLN: metilprednisolone, PDN: prednisone, DXM: dexametasone, MTX:methotrexate, CS-A: cyclosporine, LFN: leflunomide, IFX: infliximab, ETN: etanercept, AKR: anakinra TCZ: tocilizumab. Conclusions As previously described we consider rituximab as an effective therapy for severe ocular surface inflammatory diseases related to rheumatic conditions when other immunosuppressant drugs fail or are contraindicated. References [1] - Albert M, Beltrán E, Martínez-Costa L. Rituximab in rheumatoid arthritis-associated peripheral ulcerative keratitis. Arch Soc Esp Oftalmol. 2011; 86(4):118–20. [2] - Sims J. Scleritis: presentations, disease associations and management. Postgrad Med J. 2012;88(1046):713–8. [3] - Jabs DA, Mudun A, Dunn JP, Mardsh MJ. Episcleritis and scleritis: clinical features and treatment results. Am J Opthalmol2000;130:469. [4] - Suhler EB, Lim LL, Beardsley RM, Giles TR, Pasadhika S, Lee ST, et al. Rituximab therapy for refractory scleritis: results of a phase I/II dose-ranging, randomized, clinical trial. Ophthalmology. 2014;121(10):1885–91. Disclosure of Interest None declaredAbstract AB1139 – Table 1 RTX for scleritis and PUK Age (ys) Gender Ocular disease Rheumatic disease Comorbidities Previous treatment RTX cycles ΔVA Inflammatory activity AE Follow up (ms) 1 55 F PUK RA Amiloidosis MTX, CS-A, IFX, MPLN ev 1 +0.1 No No 132 2 58 F Scleritis GPA HBV chronic carrier, LTI MPLN ev, PDN 1 +0.1 No No 19 3 59 F Scleritis RP DM MTX, CS-A, PDN, DXM io 1 0 Diffuse nodular scleritis No 17 4 75 M Scleritis RP DM, Sweet’s syndrome, myelo displasic syndrome MTX, CS-A, ETN, PDN 1 +0.5 No No 11 5 75 F PUK RA Previous thyroid CA, asthma MTX, PDN 1 +0.5/+0.1 No No 25 6 60 F PUK RA No MTX, AKR, IFX, PDN 2 +0.1 No No 128 7 70 M PUK RA LTI MTX, CS-A, TCZ, PDN 1 +0.1 No No 10 8 53 F PUK RA CSC MTX, LFN, PDN 1 +0.1/0 No No 7