Therapy of ocular complications in ANCA+ associated vasculitis

Rom J Ophthalmol. 2021 Jan-Mar;65(1):10-14. doi: 10.22336/rjo.2021.3.

Abstract

ANCA+ associated vasculitis (AAV) is a group of rare diseases with potentially vision-threatening complications. Ocular and orbital complications of these diseases are caused by vasculitis of the small vessels of the eye or by granulomatous mass formation. ANCA (anti-neutrophil cytoplasmic antibodies) represent a key component of pathophysiological pathways as well as a diagnostic marker. Various manifestations are reported in literature, scleritis and episcleritis being the most common, followed by pseudotumor orbitae. In vision-threatening orbital or ocular disease, aggressive systemic treatment with a combination of high-dose glucocorticoids and either cyclophosphamide or rituximab is needed. Certain cases require locoregional surgical management to preserve ocular integrity or vision. Ocular involvement of AAV remains a challenge in clinical practice, requiring multi-specialty cooperation in order to ensure the best possible visual outcome. Abbreviations: AAV = ANCA+ associated vasculitis, ANCA = anti-neutrophil cytoplasmic antibodies, GPA = granulomatosis with polyangiitis, EGPA = eosinophilic granulomatosis with polyangiitis, MPA = microscopic polyangiitis.

Keywords: ocular; orbital; vasculitis.

Publication types

  • Review

MeSH terms

  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / drug therapy*
  • Eye Diseases / drug therapy*
  • Eye Diseases / immunology
  • Glucocorticoids / therapeutic use*
  • Humans
  • Immunologic Factors / therapeutic use
  • Rituximab / therapeutic use*

Substances

  • Glucocorticoids
  • Immunologic Factors
  • Rituximab