case_images: PMC6615868_01
case_images: During etanercept therapy in patient 1 with rheumatoid arthritis, slit-lamp examination reveals scleral hyperaemia (A). Optical coherence tomography (OCT) reveals no evidence of macular oedema (B). Four months after switching to infliximab, the anterior scleritis improved (C); however, macular oedema occurred (D). After switching to tocilizumab, both scleritis and macular oedema were completely resolved (E, F).
case_images: bmjophth-2018-000250f01.jpg
case_images: PMC6615868_01_bmjophth-2018-000250f01.jpg
case_images: F1
case_images: Posterior inflammation was not observed, and she was diagnosed with anterior scleritis (figure 1A, B). Four months after starting infliximab, scleritis improved (figure 1C), and her joint disease was also in remission. Her visual acuity decreased to 0.15, and dilated fundal examination revealed macular oedema and vitreous opacity in the left eye (figure 1D). One month after starting tocilizumab, both scleritis and macular oedema were completely resolved (figure 1E, F).
case_images: PMC6615868_02
case_images: Initial findings of slit-lamp examination and optical coherence tomography in patient 2 with rheumatoid arthritis showing severe anterior and posterior scleritis (A, B). Five months after starting infliximab, slit-lamp examination reveals no anterior scleral hyperaemia (C); however, B-mode ultrasonography reveals dense vitritis and serous retinal detachment (*) (D). After stopping infliximab and restarting steroid and immunosuppressive therapy, both anterior and posterior ocular inflammations were completely resolved (E, F).
case_images: bmjophth-2018-000250f02.jpg
case_images: PMC6615868_02_bmjophth-2018-000250f02.jpg
case_images: F2
case_images: A 50-year-old woman with RA presented with unilateral anterior and posterior scleritis (figure 2A, B). However, 5 months after starting infliximab, while anterior scleritis remained asymptomatic (figure 2C), posterior scleritis was exacerbated with severe intraocular inflammation and dense vitritis. Optical coherence tomography images could not be obtained due to the dense vitritis, and B-mode ultrasonography revealed serous retinal detachment (figure 2D). To date, no flare-up of anterior and posterior scleritis has been noted for 12 months (figure 2E, F).
case_images: PMC6615868_03
case_images: Slit-lamp examination of the left eye in patient 3 with juvenile idiopathic arthritis reveals band-shaped keratopathy, posterior synechia and cataracts (A). Ten months after starting infliximab, optical coherence tomography of the right eye reveals cystoid macular oedema (B). Cystoid macular oedema was resolved after switching to adalimumab (C).
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case_images: PMC6615868_03_bmjophth-2018-000250f03.jpg
case_images: F3
case_images: However, anterior ocular inflammation was severe, and long-term ocular complications, including band-shaped keratopathy, posterior synechia and cataracts, developed in her left eye (figure 3A). Unexpectedly, 10 months after starting infliximab, she experienced exacerbation of severe anterior uveitis in both eyes and developed macular oedema in the right eye (figure 3B). After starting adalimumab, both ocular anterior inflammation and the macular oedema were completely in remission (figure 3C).
case_images: PMC6615868_04
case_images: Fundus photograph of patient 4 with Crohn's disease demonstrating focal sheathing and retinal infiltrates (A). Fluorescein angiography reveals extensive leakage from retinal vessels (B). Optical coherence tomography of the right eye reveals cystoid macular oedema (C). Cystoid macular oedema was resolved after receiving intravitreal triamcinolone injection and switching to adalimumab (D).
case_images: bmjophth-2018-000250f04.jpg
case_images: PMC6615868_04_bmjophth-2018-000250f04.jpg
case_images: F4
case_images: Dilated fundus examination and fluorescein angiography revealed severe bilateral retinal vasculitis and macular oedema (figure 4A-C). Six months after intravitreal triamcinolone injection, macular oedema was improved in both eyes (figure 4D); however, severe retinal pigment epithelial atrophy developed in both eyes.