SlideShare uma empresa Scribd logo
1 de 83
Baixar para ler offline
How to approach and handle scleritis  三總 眼科部 蔡明霖  MD PhD
There are some problems occurred in the case with scleritis to ophthalmologist.  ,[object Object],[object Object],[object Object]
How to diagnose scleritis  to ophthalmolgist? ,[object Object],[object Object],[object Object],[object Object]
How to evaluate symptoms and sign in the case with scleritis  ,[object Object],[object Object],[object Object]
How to exclude masquerade scleritis? ,[object Object],[object Object]
Exclude masquerade scleritis ,[object Object],[object Object],[object Object]
A case with scleritis under topical steroid Tx In LMC  for 5 weeks
Watson and Hayreh1976.: S/S,  location After diagnosis, how to do classification of scleritis 50% 20-40% less rare To choose  treatment and evaluate prognosis.
Proper classification achieve proper Treatment  2010 UpToDay Guard associated with systemic illness Systemic steroid IMT(ASAP). Necrotizing anterior scleritis  Systemic steroid IMT(17%). Posterior scleritis good 50% recure NSAID(+) Systemic steroid  if necessary Nodular anterior scleritis  good Rare recur NSAID(+) Systemic steroid  if necessary Diffuse anterior scleritis  Prognosis Treatment
Topic steroid Q2h In LMC  for 7 weeks S/S persisted  Topic steroid Q2h ( 2 mons=> 47% emission) NSAID(+) improved within 2 weeks Case1. Diffuse anterior scleritis
Topic steroid Q2h  Systemic steroid in LMC (Low dose) for 5 weeks S/S persisted  NSAID(+) improved within 3 weeks Case 2. Nodular scleritis
Cases 3,4 Necrotising or posterior scleritis   Tx : Systemic steroid,+ IMT (ASAP) are necessary High incidence associated with systemic diseases
How to order exams in a case with scleritis ? ,[object Object],[object Object]
Examinations necessary?   ,[object Object],[object Object],[object Object],[object Object]
Why to find underlying disease?  ,[object Object],[object Object]
Underlying diseases in scleritis?  ( Esen et al 2005) ,[object Object],[object Object],[object Object]
RIA diseases in  scleritis  James T Rosenbaum 2007
How to find underlying diseases?  ,[object Object],[object Object],[object Object],[object Object],[object Object]
Examinations choice?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],。
Basic exams ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Optional exams   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
systemic vasculitis markers   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Image study ,[object Object],[object Object],[object Object],[object Object],[object Object],Orbital image: B scan, CT. Posterior scleritis  Wegener's granulomatosis
Biopsy is suggested in the cases with negative finings or poor response  ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
How to approach and handle scleritis   ,[object Object],[object Object],[object Object]
Treatment  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatments according to Scleritis classification   Guard associated with systemic illness Systemic steroid IMT(ASAP). Necrotizing anterior scleritis  Systemic steroid IMT(17%). Posterior scleritis good 50% recure NSAID(+) Systemic steroid  if necessary Nodular anterior scleritis  good Rare recur NSAID(+) Systemic steroid  if necessary Diffuse anterior scleritis  Prognosis Treatment
How to treat  anterior non-necrotizing scleritis?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NSAID is mainstay treatment in anterior non-necrotizing scleritis  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Topical corticosteroids is another choices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic steroid or IMT  is adjuvant treatment if necessary   ,[object Object],[object Object]
How to treat  necrotizing scleritis  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to use systemic steroid? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How to use pulse steroid? ,[object Object],[object Object],[object Object]
How to choose IMT  ,[object Object],[object Object],[object Object],[object Object],Bone marrow, renal failure CBC, U/R monitor,  initially weekly and then monthly
How to use IMT: 4 stages  ,[object Object],[object Object],[object Object],[object Object],[object Object]
How to do surgical Tx (Scleral graft) ,[object Object],[object Object],[object Object],Timing  impending rupture local stable: S/S
Donor selection and recipient evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Scleral graft procedure and post-op care  ,[object Object],[object Object],[object Object],[object Object],Post-op care  Local:  steroids, antibiotics lubricant eye drops systemic: control systemic  disease
Scleral graft evaluation  ,[object Object],[object Object],[object Object],[object Object],Outcome:  low rejection rate  ( low living cells,denature protein) high necrosis rate particularly  ( systemic  RIA disease: vessel) precipitated immune complex;  IMT is necessary)
How to manage specimens?  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Scleritis under systemic and topical steroid treatment
[object Object],[object Object]
 
Evaluation of specimens  ,[object Object]
Evaluation of specimens  ,[object Object]
Treatment ,[object Object],。
TREARMENT ,[object Object],[object Object]
IMT ,[object Object],[object Object]
video ,[object Object]
Anterior scleritis treatment Patients with necrotizing anterior scleritis and those with nonnecrotizing anterior scleritis who do not respond to NSAIDs are started on oral prednisone at 1 mg/kg/d. This dose is continued until the scleritis is quiet for 1 month. The prednisone is then slowly tapered over a few months, depending largely on how well it was tolerated by the patient. Typically, if the patient do
[object Object]
AM sclera ,[object Object]
AM sclera ,[object Object]
Scleral graft ,[object Object]
 
[object Object],[object Object],[object Object],[object Object],Why reddness 4 3 5 2
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Find underlying disease  tertiary   health center ,[object Object],[object Object],[object Object],[object Object]
Treatment  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Infectious scleritis ,[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RIA marker  ,[object Object],[object Object]
Churg-Strauss syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Diagnosis of infectious and rheumatic diseases ,[object Object]
Diagnosis of vasculitis disease ,[object Object],[object Object]
Infectious scleritis
Diagnosis of infectious disease ,[object Object]
Why Classification Less ( F; 66Y/O) associated with systemic illness Necrotizing anterior scleritis  immunosuppressive drugs (17%). Rare  oral glucocorticoids (83%)  Posterior scleritis Most cases respond to mild therapies  20-40 % NSAID(+) Steroid Nodular anterior scleritis  Most cases respond to mild therapies  50 % NSAID(+) Steroid Diffuse anterior scleritis  Prognosis Incident  Treatment
Treatment ,[object Object],[object Object]
Treatment 4 steroid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object]
Treatment ,[object Object]
Notice  ,[object Object]
consolidation ,[object Object],[object Object],[object Object]
Low immunoreactivity ,[object Object],[object Object]
Why Classification Guard  associated with systemic illness Necrotizing anterior scleritis  immunosuppressore drugs (17%). oral glucocorticoids (83%)  Posterior scleritis 50% recure NSAID(+) Steroid Nodular anterior scleritis  Rare recur NSAID(+) Steroid Diffuse anterior scleritis  Prognosis Treatment

Mais conteúdo relacionado

Mais procurados

Reducing Uveitic Glaucoma: therapeutic judgement is the key
Reducing Uveitic Glaucoma: therapeutic judgement is the keyReducing Uveitic Glaucoma: therapeutic judgement is the key
Reducing Uveitic Glaucoma: therapeutic judgement is the keyiosrphr_editor
 
Ophthal Studies & Trials
Ophthal Studies & TrialsOphthal Studies & Trials
Ophthal Studies & TrialsMeng Hsien Yong
 
Granular Corneal Dystrophy
Granular Corneal DystrophyGranular Corneal Dystrophy
Granular Corneal Dystrophypinchasmd
 
Uvea sclera 990829
Uvea sclera 990829Uvea sclera 990829
Uvea sclera 990829doc30845
 
Apocrine Hidrocystoma
Apocrine HidrocystomaApocrine Hidrocystoma
Apocrine Hidrocystomapinchasmd
 
A Rare Case Of Terson Syndrome With Subarachnoid Hemorrhage
A Rare Case Of Terson Syndrome With Subarachnoid HemorrhageA Rare Case Of Terson Syndrome With Subarachnoid Hemorrhage
A Rare Case Of Terson Syndrome With Subarachnoid HemorrhageDr. Jagannath Boramani
 
Ischemic optic neuropathy
Ischemic optic neuropathyIschemic optic neuropathy
Ischemic optic neuropathy16divya
 
Papilledema Or No Papilledema
Papilledema Or No PapilledemaPapilledema Or No Papilledema
Papilledema Or No Papilledemaneurophq8
 
open-globe injuries in palestinePalestine: epidemiology and factors associate...
open-globe injuries in palestinePalestine: epidemiology and factors associate...open-globe injuries in palestinePalestine: epidemiology and factors associate...
open-globe injuries in palestinePalestine: epidemiology and factors associate...Riyad Banayot
 
20 ophthalmology clinical cases
20 ophthalmology clinical cases20 ophthalmology clinical cases
20 ophthalmology clinical casesRiyad Banayot
 
Thyroid eye disease ( Graves Ophthalmopathy )
Thyroid eye disease  ( Graves Ophthalmopathy )Thyroid eye disease  ( Graves Ophthalmopathy )
Thyroid eye disease ( Graves Ophthalmopathy )neurophq8
 
AION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic NeuropathyAION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic NeuropathyNoor Munirah Aab
 
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptxRETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptxIddi Ndyabawe
 
Traumatic optic neuropathy
Traumatic optic neuropathyTraumatic optic neuropathy
Traumatic optic neuropathyAmr Mounir
 

Mais procurados (20)

Reducing Uveitic Glaucoma: therapeutic judgement is the key
Reducing Uveitic Glaucoma: therapeutic judgement is the keyReducing Uveitic Glaucoma: therapeutic judgement is the key
Reducing Uveitic Glaucoma: therapeutic judgement is the key
 
Opthalmology
OpthalmologyOpthalmology
Opthalmology
 
NAION
NAIONNAION
NAION
 
Ophthal Studies & Trials
Ophthal Studies & TrialsOphthal Studies & Trials
Ophthal Studies & Trials
 
Pwpt eales
Pwpt eales Pwpt eales
Pwpt eales
 
Granular Corneal Dystrophy
Granular Corneal DystrophyGranular Corneal Dystrophy
Granular Corneal Dystrophy
 
Uvea sclera 990829
Uvea sclera 990829Uvea sclera 990829
Uvea sclera 990829
 
Apocrine Hidrocystoma
Apocrine HidrocystomaApocrine Hidrocystoma
Apocrine Hidrocystoma
 
Central Serous Chorioretinopathy
Central Serous ChorioretinopathyCentral Serous Chorioretinopathy
Central Serous Chorioretinopathy
 
A Rare Case Of Terson Syndrome With Subarachnoid Hemorrhage
A Rare Case Of Terson Syndrome With Subarachnoid HemorrhageA Rare Case Of Terson Syndrome With Subarachnoid Hemorrhage
A Rare Case Of Terson Syndrome With Subarachnoid Hemorrhage
 
Ischemic optic neuropathy
Ischemic optic neuropathyIschemic optic neuropathy
Ischemic optic neuropathy
 
Papilledema Or No Papilledema
Papilledema Or No PapilledemaPapilledema Or No Papilledema
Papilledema Or No Papilledema
 
open-globe injuries in palestinePalestine: epidemiology and factors associate...
open-globe injuries in palestinePalestine: epidemiology and factors associate...open-globe injuries in palestinePalestine: epidemiology and factors associate...
open-globe injuries in palestinePalestine: epidemiology and factors associate...
 
20 ophthalmology clinical cases
20 ophthalmology clinical cases20 ophthalmology clinical cases
20 ophthalmology clinical cases
 
Thyroid eye disease ( Graves Ophthalmopathy )
Thyroid eye disease  ( Graves Ophthalmopathy )Thyroid eye disease  ( Graves Ophthalmopathy )
Thyroid eye disease ( Graves Ophthalmopathy )
 
AION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic NeuropathyAION Anterior Ischemic Optic Neuropathy
AION Anterior Ischemic Optic Neuropathy
 
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptxRETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
 
Traumatic optic neuropathy
Traumatic optic neuropathyTraumatic optic neuropathy
Traumatic optic neuropathy
 
Normal tension glaucoma
Normal tension glaucomaNormal tension glaucoma
Normal tension glaucoma
 
Glaucomatocyclitic Crisis
Glaucomatocyclitic CrisisGlaucomatocyclitic Crisis
Glaucomatocyclitic Crisis
 

Semelhante a Scleritis professor 1001030

Scleritis & episcleritis
Scleritis & episcleritisScleritis & episcleritis
Scleritis & episcleritisPramod Sharma
 
Septic shock; latest update
Septic shock; latest updateSeptic shock; latest update
Septic shock; latest updateRamadan Arafa
 
CASE SENERIO Dr Ayman RefaieMD
 CASE SENERIO  Dr Ayman RefaieMD CASE SENERIO  Dr Ayman RefaieMD
CASE SENERIO Dr Ayman RefaieMDFAARRAG
 
Adrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryAdrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryShakila Rifat
 
Adrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryAdrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryShakila Rifat
 
Adrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryAdrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryShakila Rifat
 
Mmc1 2 The Lancet - Supplementary appendix 10/15/2014
Mmc1 2 The Lancet - Supplementary appendix 10/15/2014Mmc1 2 The Lancet - Supplementary appendix 10/15/2014
Mmc1 2 The Lancet - Supplementary appendix 10/15/2014John Redaelli
 
Primary cns lymphoma ppt
Primary cns lymphoma pptPrimary cns lymphoma ppt
Primary cns lymphoma pptShashank Bansal
 
Microbiological Investigation of Osteo-articular infections
Microbiological Investigation of Osteo-articular infectionsMicrobiological Investigation of Osteo-articular infections
Microbiological Investigation of Osteo-articular infectionsMahen Kothalawala
 
Fedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.p
Fedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.pFedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.p
Fedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.pEAFO2014
 
Evidence basedcritcare06
Evidence basedcritcare06Evidence basedcritcare06
Evidence basedcritcare06Hayk Antonyan
 
Evidence basedcritcare06
Evidence basedcritcare06Evidence basedcritcare06
Evidence basedcritcare06Hayk Antonyan
 
Kshivets O. Lung Cancer: Early Detection and Diagnosis
Kshivets O. Lung Cancer: Early Detection and Diagnosis Kshivets O. Lung Cancer: Early Detection and Diagnosis
Kshivets O. Lung Cancer: Early Detection and Diagnosis Oleg Kshivets
 

Semelhante a Scleritis professor 1001030 (20)

Scleritis & episcleritis
Scleritis & episcleritisScleritis & episcleritis
Scleritis & episcleritis
 
Management of Sepsis
Management of SepsisManagement of Sepsis
Management of Sepsis
 
Septic shock; latest update
Septic shock; latest updateSeptic shock; latest update
Septic shock; latest update
 
CASE SENERIO Dr Ayman RefaieMD
 CASE SENERIO  Dr Ayman RefaieMD CASE SENERIO  Dr Ayman RefaieMD
CASE SENERIO Dr Ayman RefaieMD
 
Adrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryAdrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhury
 
Adrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryAdrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhury
 
Adrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhuryAdrenal ca dr.sharfuddin chowdhury
Adrenal ca dr.sharfuddin chowdhury
 
Resistin
ResistinResistin
Resistin
 
Seminoma eau
Seminoma eauSeminoma eau
Seminoma eau
 
Mmc1 2 The Lancet - Supplementary appendix 10/15/2014
Mmc1 2 The Lancet - Supplementary appendix 10/15/2014Mmc1 2 The Lancet - Supplementary appendix 10/15/2014
Mmc1 2 The Lancet - Supplementary appendix 10/15/2014
 
Primary cns lymphoma ppt
Primary cns lymphoma pptPrimary cns lymphoma ppt
Primary cns lymphoma ppt
 
Microbiological Investigation of Osteo-articular infections
Microbiological Investigation of Osteo-articular infectionsMicrobiological Investigation of Osteo-articular infections
Microbiological Investigation of Osteo-articular infections
 
Fedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.p
Fedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.pFedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.p
Fedorenko_Denis_A.novik memorial lecture iv hematology forum_2016_st.p
 
215 antibio
215 antibio215 antibio
215 antibio
 
215 antibio
215 antibio215 antibio
215 antibio
 
Acute meningitis
Acute meningitisAcute meningitis
Acute meningitis
 
Evidence basedcritcare06
Evidence basedcritcare06Evidence basedcritcare06
Evidence basedcritcare06
 
Evidence basedcritcare06
Evidence basedcritcare06Evidence basedcritcare06
Evidence basedcritcare06
 
Sepsis
SepsisSepsis
Sepsis
 
Kshivets O. Lung Cancer: Early Detection and Diagnosis
Kshivets O. Lung Cancer: Early Detection and Diagnosis Kshivets O. Lung Cancer: Early Detection and Diagnosis
Kshivets O. Lung Cancer: Early Detection and Diagnosis
 

Mais de doc30845

台科大102 3書面報告題目
台科大102 3書面報告題目台科大102 3書面報告題目
台科大102 3書面報告題目doc30845
 
台科大102 3課表
台科大102 3課表台科大102 3課表
台科大102 3課表doc30845
 
台科大102 2課表
台科大102 2課表台科大102 2課表
台科大102 2課表doc30845
 
M83通訊錄10108 23
M83通訊錄10108 23M83通訊錄10108 23
M83通訊錄10108 23doc30845
 
2012 台科大課程表
2012 台科大課程表2012 台科大課程表
2012 台科大課程表doc30845
 
20120927 台科大 oct原理及在眼科的應用 (1)
20120927 台科大 oct原理及在眼科的應用 (1)20120927 台科大 oct原理及在眼科的應用 (1)
20120927 台科大 oct原理及在眼科的應用 (1)doc30845
 
Clinical laboratory basic
Clinical laboratory basicClinical laboratory basic
Clinical laboratory basicdoc30845
 
20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]
20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]
20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]doc30845
 
醫學工程於皮膚與毛髮醫學的應用
醫學工程於皮膚與毛髮醫學的應用醫學工程於皮膚與毛髮醫學的應用
醫學工程於皮膚與毛髮醫學的應用doc30845
 
台科大 助聽器到電子耳 03042012 2
台科大 助聽器到電子耳 03042012 2台科大 助聽器到電子耳 03042012 2
台科大 助聽器到電子耳 03042012 2doc30845
 
人工電子耳 台科大 1
人工電子耳 台科大 1人工電子耳 台科大 1
人工電子耳 台科大 1doc30845
 
牙科醫學工程學
牙科醫學工程學牙科醫學工程學
牙科醫學工程學doc30845
 
修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1doc30845
 
修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1doc30845
 
1010223常用視覺輔具 吳文陽老師講義 (1)
1010223常用視覺輔具 吳文陽老師講義 (1)1010223常用視覺輔具 吳文陽老師講義 (1)
1010223常用視覺輔具 吳文陽老師講義 (1)doc30845
 
醫學工程概論101 1
醫學工程概論101 1醫學工程概論101 1
醫學工程概論101 1doc30845
 
0216 金守仁
0216 金守仁0216 金守仁
0216 金守仁doc30845
 
台科大課表
台科大課表台科大課表
台科大課表doc30845
 
台科大課表
台科大課表台科大課表
台科大課表doc30845
 
台科大課表
台科大課表台科大課表
台科大課表doc30845
 

Mais de doc30845 (20)

台科大102 3書面報告題目
台科大102 3書面報告題目台科大102 3書面報告題目
台科大102 3書面報告題目
 
台科大102 3課表
台科大102 3課表台科大102 3課表
台科大102 3課表
 
台科大102 2課表
台科大102 2課表台科大102 2課表
台科大102 2課表
 
M83通訊錄10108 23
M83通訊錄10108 23M83通訊錄10108 23
M83通訊錄10108 23
 
2012 台科大課程表
2012 台科大課程表2012 台科大課程表
2012 台科大課程表
 
20120927 台科大 oct原理及在眼科的應用 (1)
20120927 台科大 oct原理及在眼科的應用 (1)20120927 台科大 oct原理及在眼科的應用 (1)
20120927 台科大 oct原理及在眼科的應用 (1)
 
Clinical laboratory basic
Clinical laboratory basicClinical laboratory basic
Clinical laboratory basic
 
20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]
20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]
20120510(print台科大) 醫學工程於鑑識科學的應用60min [相容模式]
 
醫學工程於皮膚與毛髮醫學的應用
醫學工程於皮膚與毛髮醫學的應用醫學工程於皮膚與毛髮醫學的應用
醫學工程於皮膚與毛髮醫學的應用
 
台科大 助聽器到電子耳 03042012 2
台科大 助聽器到電子耳 03042012 2台科大 助聽器到電子耳 03042012 2
台科大 助聽器到電子耳 03042012 2
 
人工電子耳 台科大 1
人工電子耳 台科大 1人工電子耳 台科大 1
人工電子耳 台科大 1
 
牙科醫學工程學
牙科醫學工程學牙科醫學工程學
牙科醫學工程學
 
修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1
 
修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1修正1010223常用視覺輔具 劉祥瑞老師講義 1
修正1010223常用視覺輔具 劉祥瑞老師講義 1
 
1010223常用視覺輔具 吳文陽老師講義 (1)
1010223常用視覺輔具 吳文陽老師講義 (1)1010223常用視覺輔具 吳文陽老師講義 (1)
1010223常用視覺輔具 吳文陽老師講義 (1)
 
醫學工程概論101 1
醫學工程概論101 1醫學工程概論101 1
醫學工程概論101 1
 
0216 金守仁
0216 金守仁0216 金守仁
0216 金守仁
 
台科大課表
台科大課表台科大課表
台科大課表
 
台科大課表
台科大課表台科大課表
台科大課表
 
台科大課表
台科大課表台科大課表
台科大課表
 

Último

Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 

Último (20)

Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 

Scleritis professor 1001030

  • 1. How to approach and handle scleritis 三總 眼科部 蔡明霖 MD PhD
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7. A case with scleritis under topical steroid Tx In LMC for 5 weeks
  • 8. Watson and Hayreh1976.: S/S, location After diagnosis, how to do classification of scleritis 50% 20-40% less rare To choose treatment and evaluate prognosis.
  • 9. Proper classification achieve proper Treatment 2010 UpToDay Guard associated with systemic illness Systemic steroid IMT(ASAP). Necrotizing anterior scleritis Systemic steroid IMT(17%). Posterior scleritis good 50% recure NSAID(+) Systemic steroid if necessary Nodular anterior scleritis good Rare recur NSAID(+) Systemic steroid if necessary Diffuse anterior scleritis Prognosis Treatment
  • 10. Topic steroid Q2h In LMC for 7 weeks S/S persisted Topic steroid Q2h ( 2 mons=> 47% emission) NSAID(+) improved within 2 weeks Case1. Diffuse anterior scleritis
  • 11. Topic steroid Q2h Systemic steroid in LMC (Low dose) for 5 weeks S/S persisted NSAID(+) improved within 3 weeks Case 2. Nodular scleritis
  • 12. Cases 3,4 Necrotising or posterior scleritis Tx : Systemic steroid,+ IMT (ASAP) are necessary High incidence associated with systemic diseases
  • 13.
  • 14.
  • 15.
  • 16.
  • 17. RIA diseases in scleritis James T Rosenbaum 2007
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28. Treatments according to Scleritis classification Guard associated with systemic illness Systemic steroid IMT(ASAP). Necrotizing anterior scleritis Systemic steroid IMT(17%). Posterior scleritis good 50% recure NSAID(+) Systemic steroid if necessary Nodular anterior scleritis good Rare recur NSAID(+) Systemic steroid if necessary Diffuse anterior scleritis Prognosis Treatment
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43. Scleritis under systemic and topical steroid treatment
  • 44.
  • 45.  
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
  • 51.
  • 52. Anterior scleritis treatment Patients with necrotizing anterior scleritis and those with nonnecrotizing anterior scleritis who do not respond to NSAIDs are started on oral prednisone at 1 mg/kg/d. This dose is continued until the scleritis is quiet for 1 month. The prednisone is then slowly tapered over a few months, depending largely on how well it was tolerated by the patient. Typically, if the patient do
  • 53.
  • 54.
  • 55.
  • 56.
  • 57.  
  • 58.
  • 59.  
  • 60.
  • 61.
  • 62.
  • 63.
  • 64.
  • 65.
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71.
  • 73.
  • 74. Why Classification Less ( F; 66Y/O) associated with systemic illness Necrotizing anterior scleritis immunosuppressive drugs (17%). Rare oral glucocorticoids (83%) Posterior scleritis Most cases respond to mild therapies 20-40 % NSAID(+) Steroid Nodular anterior scleritis Most cases respond to mild therapies 50 % NSAID(+) Steroid Diffuse anterior scleritis Prognosis Incident Treatment
  • 75.
  • 76.
  • 77.
  • 78.
  • 79.
  • 80.
  • 81.
  • 82.
  • 83. Why Classification Guard associated with systemic illness Necrotizing anterior scleritis immunosuppressore drugs (17%). oral glucocorticoids (83%) Posterior scleritis 50% recure NSAID(+) Steroid Nodular anterior scleritis Rare recur NSAID(+) Steroid Diffuse anterior scleritis Prognosis Treatment

Notas do Editor

  1. 碰到鞏膜炎可能會碰到三個問題 How to confirm scleritis ; How to find underline diseases ; How to treatment 希望能在這幾分鐘的報告對大家有助益
  2. How to confirm scleritis 首先先看 S/S 再 Exclude masquerade scleritis 然後將 scleritis 分類以利治療
  3. scleritis S/S 一般為紅腫痛
  4. Scleritis 病人必須要有 thorough examination 及對 treatment-resistant scleritis 的病人細心的 approach 才可以找出 masquerade scleritis 避免誤診
  5. 此外要與 Episcleritis Intraocular malignant
  6. 最後這是一位由 LMC refer 他在外面點兩個哥月的類固醇 Trace Hx 發現病人有 breast Ca 病使景眼內有 mass 頸部有腫塊 後來病理學發現是 lung Ca meta 到眼內 病人用藥後病情進步
  7. Watson and Hayreh1976. 根據位置與症狀 將 scleritis 分類
  8. 為何要分類 因為適當的 scleritis 分類對 Treatment : prognosis 有相當的幫助 例如 anterior scleritis 用 NSAID 效果就不錯了而 necrotizing 則要用 IMT
  9. Necrotising or posterior scleritis 一般需要 IMT
  10. 我們碰到的問題是此 scleritis 是否與 systemic disease 有相關 ? (2009 uptoday evidence-base database) 顯示出 50% 與 systemic disease 有相關
  11. James T Rosenbaum2007 43% idiopathic 48% RIA diseases 7% infectious
  12. 最後這是一位由 LMC refer 他在外面點及吃了兩個哥月的類固醇後來檢查為 HIV 與 syphilis 病人用藥後病情進步 Scleritis 病人必須要有 thorough examination 及對 treatment-resistant scleritis 的病人細心的 approach 才可以早期發現早期治療