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Published in: Ophthalmology and Therapy 2/2019

Open Access 01-06-2019 | Vasculitis | Review

Ocular Manifestations of Granulomatosis with Polyangiitis: A Review of the Literature

Authors: Evdokia Sfiniadaki, Ioanna Tsiara, Panagiotis Theodossiadis, Irini Chatziralli

Published in: Ophthalmology and Therapy | Issue 2/2019

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Abstract

Granulomatosis with polyangiitis (GPA) is a rare systemic autoimmune disease of unknown etiology that is characterized by granulomatous inflammation, tissue necrosis, and vasculitis in small- and medium-sized vessels. Ocular and orbital manifestations are common in almost half of patients with GPA, affecting every structure of the eye, from the eyelid and orbit to the retina, the choroid, and the optic nerve, with a wide range of severity. Since imaging findings are not always specific for the diagnosis of GPA, biopsy is useful to confirm the diagnosis. Regarding treatment, a localized pharmaceutical and surgical approach may be helpful to achieve remission, while immunosuppressive therapy, corticosteroids, and cyclosporine are also useful. In any case, multidisciplinary intervention is required to reduce the rates of relapse and morbidity in patients with GPA.
Literature
1.
go back to reference Catanoso M, Macchioni P, Boiardi L, et al. Epidemiology of granulomatosis with polyangiitis (Wegener’s granulomatosis) in Northern Italy: a 15-year population-based study. Semin Arthritis Rheum. 2014;44(2):202–7.CrossRef Catanoso M, Macchioni P, Boiardi L, et al. Epidemiology of granulomatosis with polyangiitis (Wegener’s granulomatosis) in Northern Italy: a 15-year population-based study. Semin Arthritis Rheum. 2014;44(2):202–7.CrossRef
2.
go back to reference Greco A, Marinelli C, Fusconi M, et al. Clinic manifestations in granulomatosis with polyangiitis. Int J Immunopathol Pharmacol. 2016;29(2):151–9.CrossRef Greco A, Marinelli C, Fusconi M, et al. Clinic manifestations in granulomatosis with polyangiitis. Int J Immunopathol Pharmacol. 2016;29(2):151–9.CrossRef
3.
go back to reference Comarmond C, Cacoub P. Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. Autoimmun Rev. 2014;13(11):1121–5.CrossRef Comarmond C, Cacoub P. Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. Autoimmun Rev. 2014;13(11):1121–5.CrossRef
4.
go back to reference Tarabishy AB, Schulte M, Papaliodis GN, Hoffman GS. Wegener’s granulomatosis: clinical manifestations, differential diagnosis, and management of ocular and systemic disease. Surv Ophthalmol. 2010;55(5):429–44.CrossRef Tarabishy AB, Schulte M, Papaliodis GN, Hoffman GS. Wegener’s granulomatosis: clinical manifestations, differential diagnosis, and management of ocular and systemic disease. Surv Ophthalmol. 2010;55(5):429–44.CrossRef
5.
go back to reference Csernok E, Gross WL. Current understanding of the pathogenesis of granulomatosis with polyangiitis (Wegener’s). Expert Rev Clin Immunol. 2013;9(7):641–8.CrossRef Csernok E, Gross WL. Current understanding of the pathogenesis of granulomatosis with polyangiitis (Wegener’s). Expert Rev Clin Immunol. 2013;9(7):641–8.CrossRef
6.
go back to reference Xie G, Roshandel D, Sherva R, et al. Association of granulomatosis with polyangiitis (Wegener’s) with HLA-DPB1*04 and SEMA6A gene variants: evidence from genome-wide analysis. Arthritis Rheumatol. 2013;65(9):2457–68.CrossRef Xie G, Roshandel D, Sherva R, et al. Association of granulomatosis with polyangiitis (Wegener’s) with HLA-DPB1*04 and SEMA6A gene variants: evidence from genome-wide analysis. Arthritis Rheumatol. 2013;65(9):2457–68.CrossRef
7.
go back to reference Martorana D, Maritati F, Malerba G, et al. PTPN22 R620W polymorphism in the ANCA-associated vasculitides. Rheumatology. 2012;51(5):805–12.CrossRef Martorana D, Maritati F, Malerba G, et al. PTPN22 R620W polymorphism in the ANCA-associated vasculitides. Rheumatology. 2012;51(5):805–12.CrossRef
8.
go back to reference Hadzik-Blaszczyk M, Zdral A, Zielonka TM, et al. SERPINA1 gene variants in granulomatosis with polyangiitis. Adv Exp Med Biol. 2018;1070:9–18.CrossRef Hadzik-Blaszczyk M, Zdral A, Zielonka TM, et al. SERPINA1 gene variants in granulomatosis with polyangiitis. Adv Exp Med Biol. 2018;1070:9–18.CrossRef
9.
go back to reference Iannella G, Greco A, Granata G, et al. Granulomatosis with polyangiitis and facial palsy: literature review and insight in the autoimmune pathogenesis. Autoimmun Rev. 2016;15(7):621–31.CrossRef Iannella G, Greco A, Granata G, et al. Granulomatosis with polyangiitis and facial palsy: literature review and insight in the autoimmune pathogenesis. Autoimmun Rev. 2016;15(7):621–31.CrossRef
10.
go back to reference Chipczyńska B, Grałek M, Hautz W, et al. Orbital tumor as an initial manifestation of Wegener’s granulomatosis in children: a series of four cases. Med Sci Monit. 2009;15(8):CS135–8.PubMed Chipczyńska B, Grałek M, Hautz W, et al. Orbital tumor as an initial manifestation of Wegener’s granulomatosis in children: a series of four cases. Med Sci Monit. 2009;15(8):CS135–8.PubMed
12.
go back to reference Hibino M, Kondo T. Dacryoadenitis with ptosis and diplopia as the initial presentation of granulomatosis with polyangiitis. Intern Med. 2017;56(19):2649–53.CrossRef Hibino M, Kondo T. Dacryoadenitis with ptosis and diplopia as the initial presentation of granulomatosis with polyangiitis. Intern Med. 2017;56(19):2649–53.CrossRef
13.
go back to reference Muller K, Lin JH. Orbital granulomatosis with polyangiitis (Wegener granulomatosis): clinical and pathologic findings. Arch Pathol Lab Med. 2014;138(8):1110–4.CrossRef Muller K, Lin JH. Orbital granulomatosis with polyangiitis (Wegener granulomatosis): clinical and pathologic findings. Arch Pathol Lab Med. 2014;138(8):1110–4.CrossRef
14.
go back to reference Ure E, Kayadibi Y, Sanli DT, Hasiloglu ZI. Orbital involvement as the initial presentation of Wegener granulomatosis in a 9-year-old girl: MR imaging findings. Diagn Interv Imaging. 2016;97(11):1181–2.CrossRef Ure E, Kayadibi Y, Sanli DT, Hasiloglu ZI. Orbital involvement as the initial presentation of Wegener granulomatosis in a 9-year-old girl: MR imaging findings. Diagn Interv Imaging. 2016;97(11):1181–2.CrossRef
15.
go back to reference Ghanem RC, Chang N, Aoki L, Santo RM, Matayoshi S. Vasculitis of the lacrimal sac wall in Wegener granulomatosis. Ophthalmic Plast Reconstr Surg. 2004;20(3):254–7.CrossRef Ghanem RC, Chang N, Aoki L, Santo RM, Matayoshi S. Vasculitis of the lacrimal sac wall in Wegener granulomatosis. Ophthalmic Plast Reconstr Surg. 2004;20(3):254–7.CrossRef
16.
go back to reference Hello M, Barbarot S, Masseau A, Cassagnau E, Hamidou M. Xanthelasma associated with Wegener’s granulomatosis. Ann Dermatol Venereol. 2010;137(2):107–10.CrossRef Hello M, Barbarot S, Masseau A, Cassagnau E, Hamidou M. Xanthelasma associated with Wegener’s granulomatosis. Ann Dermatol Venereol. 2010;137(2):107–10.CrossRef
17.
go back to reference Tullo AB, Durrington P, Graham E, et al. Florid xanthelasmata (yellow lids) in orbital Wegener’s granulomatosis. Br J Ophthalmol. 1995;79(5):453–6.CrossRef Tullo AB, Durrington P, Graham E, et al. Florid xanthelasmata (yellow lids) in orbital Wegener’s granulomatosis. Br J Ophthalmol. 1995;79(5):453–6.CrossRef
18.
go back to reference Jordan DR, Zafar A, Brownstein S, Faraji H. Cicatricial conjunctival inflammation with trichiasis as the presenting feature of Wegener granulomatosis. Ophthalmic Plast Reconstr Surg. 2006;22(1):69–71.CrossRef Jordan DR, Zafar A, Brownstein S, Faraji H. Cicatricial conjunctival inflammation with trichiasis as the presenting feature of Wegener granulomatosis. Ophthalmic Plast Reconstr Surg. 2006;22(1):69–71.CrossRef
19.
go back to reference Miserocchi E, Waheed NK, Baltatzis S, Foster CS. Chronic cicatrizing conjunctivitis in a patient with ocular cicatricial pemphigoid and fatal Wegener granulomatosis. Am J Ophthalmol. 2001;132(6):923–4.CrossRef Miserocchi E, Waheed NK, Baltatzis S, Foster CS. Chronic cicatrizing conjunctivitis in a patient with ocular cicatricial pemphigoid and fatal Wegener granulomatosis. Am J Ophthalmol. 2001;132(6):923–4.CrossRef
20.
go back to reference Robinson MR, Lee SS, Sneller MC, Lerner R, Langford CA, Talar-Williams C, Cox TA, Chan CC, Smith JA. Tarsal-conjunctival disease associated with Wegener’s granulomatosis. Ophthalmology. 2003;110(9):1770–80.CrossRef Robinson MR, Lee SS, Sneller MC, Lerner R, Langford CA, Talar-Williams C, Cox TA, Chan CC, Smith JA. Tarsal-conjunctival disease associated with Wegener’s granulomatosis. Ophthalmology. 2003;110(9):1770–80.CrossRef
21.
go back to reference Sadiq SA, Jennings CR, Jones NS, Downes RN. Wegener’s granulomatosis: the ocular manifestations revisited. Orbit. 2000;19(4):253–61.CrossRef Sadiq SA, Jennings CR, Jones NS, Downes RN. Wegener’s granulomatosis: the ocular manifestations revisited. Orbit. 2000;19(4):253–61.CrossRef
22.
go back to reference Hoffman GS, Kerr GS, Leavitt RY, et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med. 1992;116(6):488–98.CrossRef Hoffman GS, Kerr GS, Leavitt RY, et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med. 1992;116(6):488–98.CrossRef
23.
go back to reference Cocho L, Gonzalez-Gonzalez LA, Molina-Prat N, Doctor P, Sainz-de-la-Maza M, Foster CS. Scleritis in patients with granulomatosis with polyangiitis (Wegener). Br J Ophthalmol. 2016;100(8):1062–5.CrossRef Cocho L, Gonzalez-Gonzalez LA, Molina-Prat N, Doctor P, Sainz-de-la-Maza M, Foster CS. Scleritis in patients with granulomatosis with polyangiitis (Wegener). Br J Ophthalmol. 2016;100(8):1062–5.CrossRef
24.
go back to reference Arnavaz AB, Freissler K, Lang GE. Posterior scleritis in Wegener disease. Ophthalmologe. 1997;94(8):595–9.CrossRef Arnavaz AB, Freissler K, Lang GE. Posterior scleritis in Wegener disease. Ophthalmologe. 1997;94(8):595–9.CrossRef
25.
go back to reference Fortney AC, Chodosh J. Conjunctival ulceration in recurrent Wegener granulomatosis. Cornea. 2002;21(6):623–4.CrossRef Fortney AC, Chodosh J. Conjunctival ulceration in recurrent Wegener granulomatosis. Cornea. 2002;21(6):623–4.CrossRef
26.
go back to reference Cao Y, Zhang W, Wu J, Zhang H, Zhou H. Peripheral ulcerative keratitis associated with autoimmune disease: pathogenesis and treatment. J Ophthalmol. 2017;2017:7298026.CrossRef Cao Y, Zhang W, Wu J, Zhang H, Zhou H. Peripheral ulcerative keratitis associated with autoimmune disease: pathogenesis and treatment. J Ophthalmol. 2017;2017:7298026.CrossRef
27.
go back to reference Reynolds I, Tullo AB, John SL, Holt PJ, Hillarby MC. Corneal epithelial-specific cytokeratin 3 is an autoantigen in Wegener’s granulomatosis-associated peripheral ulcerative keratitis. Investig Ophthalmol Vis Sci. 1999;40(9):2147–51. Reynolds I, Tullo AB, John SL, Holt PJ, Hillarby MC. Corneal epithelial-specific cytokeratin 3 is an autoantigen in Wegener’s granulomatosis-associated peripheral ulcerative keratitis. Investig Ophthalmol Vis Sci. 1999;40(9):2147–51.
28.
go back to reference Reddy SC, Tajunisah I, Rohana T. Bilateral scleromalacia perforans and peripheral corneal thinning in Wegener’s granulomatosis. Int J Ophthalmol. 2011;4(4):439–42.PubMedPubMedCentral Reddy SC, Tajunisah I, Rohana T. Bilateral scleromalacia perforans and peripheral corneal thinning in Wegener’s granulomatosis. Int J Ophthalmol. 2011;4(4):439–42.PubMedPubMedCentral
29.
go back to reference Wang M, Khurana RN, Sadda SR. Central retinal vein occlusion in Wegener’s granulomatosis without retinal vasculitis. Br J Ophthalmol. 2006;90(11):1435–6.CrossRef Wang M, Khurana RN, Sadda SR. Central retinal vein occlusion in Wegener’s granulomatosis without retinal vasculitis. Br J Ophthalmol. 2006;90(11):1435–6.CrossRef
30.
go back to reference Lozano-López V, Rodríguez-Lozano B, Losada-Castillo MJ, Delgado-Frías E, Dopazo-Luque D, Serrano-García M. Central retinal artery occlusion in Wegener’s granulomatosis: a diagnostic dilemma. J Ophthalmic Inflamm Infect. 2011;1(2):71–5.CrossRef Lozano-López V, Rodríguez-Lozano B, Losada-Castillo MJ, Delgado-Frías E, Dopazo-Luque D, Serrano-García M. Central retinal artery occlusion in Wegener’s granulomatosis: a diagnostic dilemma. J Ophthalmic Inflamm Infect. 2011;1(2):71–5.CrossRef
31.
go back to reference Proia AD. Granulomatous choroiditis in Wegener granulomatosis. Arch Ophthalmol. 2011;129(4):520–1.CrossRef Proia AD. Granulomatous choroiditis in Wegener granulomatosis. Arch Ophthalmol. 2011;129(4):520–1.CrossRef
32.
go back to reference Lim LT, Vasudevan V, Shelton J, Vitale AT, Moorthy R. Macula retinal vasculitis and choroiditis associated with granulomatosis with polyangiitis. Retin Cases Brief Rep. 2017;11(2):119–22.CrossRef Lim LT, Vasudevan V, Shelton J, Vitale AT, Moorthy R. Macula retinal vasculitis and choroiditis associated with granulomatosis with polyangiitis. Retin Cases Brief Rep. 2017;11(2):119–22.CrossRef
33.
go back to reference Jaben SL, Norton EW. Exudative retinal detachment in Wegener’s granulomatosis: case report. Ann Ophthalmol. 1982;14(8):717–20.PubMed Jaben SL, Norton EW. Exudative retinal detachment in Wegener’s granulomatosis: case report. Ann Ophthalmol. 1982;14(8):717–20.PubMed
34.
go back to reference Takazawa T, Ikeda K, Nagaoka T, et al. Wegener granulomatosis-associated optic perineuritis. Orbit. 2014;33(1):13–6.CrossRef Takazawa T, Ikeda K, Nagaoka T, et al. Wegener granulomatosis-associated optic perineuritis. Orbit. 2014;33(1):13–6.CrossRef
35.
go back to reference Purvin V, Kawasaki A. Optic perineuritis secondary to Wegener’s granulomatosis. Clin Exp Ophthalmol. 2009;37(7):712–7.CrossRef Purvin V, Kawasaki A. Optic perineuritis secondary to Wegener’s granulomatosis. Clin Exp Ophthalmol. 2009;37(7):712–7.CrossRef
36.
go back to reference Moubayed SP, Black DO. Optic neuritis as an initial presentation of Wegener’s granulomatosis. Can J Ophthalmol. 2009;44(6):e59.CrossRef Moubayed SP, Black DO. Optic neuritis as an initial presentation of Wegener’s granulomatosis. Can J Ophthalmol. 2009;44(6):e59.CrossRef
37.
go back to reference Niskopoulou M, Du Toit N. Optic neuritis as a feature of Wegener’s granulomatosis. Eye. 2002;16(3):320–1.CrossRef Niskopoulou M, Du Toit N. Optic neuritis as a feature of Wegener’s granulomatosis. Eye. 2002;16(3):320–1.CrossRef
38.
go back to reference Monteiro ML, Borges WI, do Val Ferreira Ramos C, Lucato LT, Leite CC. Bilateral optic neuritis in Wegener granulomatosis. J Neuroophthalmol. 2005;25(1):25–8.CrossRef Monteiro ML, Borges WI, do Val Ferreira Ramos C, Lucato LT, Leite CC. Bilateral optic neuritis in Wegener granulomatosis. J Neuroophthalmol. 2005;25(1):25–8.CrossRef
39.
go back to reference Nowack R, Wachtler P, Kunz J, Rasmussen N. Cranial nerve palsy in Wegener’s granulomatosis—lessons from clinical cases. J Neurol. 2009;256(3):299–304.CrossRef Nowack R, Wachtler P, Kunz J, Rasmussen N. Cranial nerve palsy in Wegener’s granulomatosis—lessons from clinical cases. J Neurol. 2009;256(3):299–304.CrossRef
40.
go back to reference Garrity JA. Ocular manifestations of small-vessel vasculitis. Cleve Clin J Med. 2012;79(Suppl 3):S31–3.CrossRef Garrity JA. Ocular manifestations of small-vessel vasculitis. Cleve Clin J Med. 2012;79(Suppl 3):S31–3.CrossRef
41.
go back to reference Kubaisi B, Abu Samra K, Foster CS. Granulomatosis with polyangiitis (Wegener’s disease): an updated review of ocular disease manifestations. Intractable Rare Dis Res. 2016;5(2):61–9.CrossRef Kubaisi B, Abu Samra K, Foster CS. Granulomatosis with polyangiitis (Wegener’s disease): an updated review of ocular disease manifestations. Intractable Rare Dis Res. 2016;5(2):61–9.CrossRef
42.
go back to reference Saadoun D, Bodaghi B, Bienvenu B, Wechsler B, Sene D, Trad S, Abad S, Cacoub P, Kodjikian L, Sève P. Biotherapies in inflammatory ocular disorders: interferons, immunoglobulins, monoclonal antibodies. Autoimmun Rev. 2013;12(7):774–83.CrossRef Saadoun D, Bodaghi B, Bienvenu B, Wechsler B, Sene D, Trad S, Abad S, Cacoub P, Kodjikian L, Sève P. Biotherapies in inflammatory ocular disorders: interferons, immunoglobulins, monoclonal antibodies. Autoimmun Rev. 2013;12(7):774–83.CrossRef
43.
go back to reference Doctor P, Sultan A, Syed S, Christen W, Bhat P, Foster CS. Infliximab for the treatment of refractory scleritis. Br J Ophthalmol. 2010;94(5):579–83.CrossRef Doctor P, Sultan A, Syed S, Christen W, Bhat P, Foster CS. Infliximab for the treatment of refractory scleritis. Br J Ophthalmol. 2010;94(5):579–83.CrossRef
44.
go back to reference You C, Ma L, Lasave AF, Foster CS. Rituximab induction and maintenance treatment in patients with scleritis and granulomatosis with polyangiitis (Wegener’s). Ocul Immunol Inflamm. 2018;26(8):1166–73.CrossRef You C, Ma L, Lasave AF, Foster CS. Rituximab induction and maintenance treatment in patients with scleritis and granulomatosis with polyangiitis (Wegener’s). Ocul Immunol Inflamm. 2018;26(8):1166–73.CrossRef
45.
go back to reference Huerva V, Sanchez MC, Traveset A, Jurjo C, Ruiz A. Rituximab for peripheral ulcerative keratitis with Wegener granulomatosis. Cornea. 2010;29(6):708–10.CrossRef Huerva V, Sanchez MC, Traveset A, Jurjo C, Ruiz A. Rituximab for peripheral ulcerative keratitis with Wegener granulomatosis. Cornea. 2010;29(6):708–10.CrossRef
46.
go back to reference Ahmed A, Foster CS. Cyclophosphamide or rituximab treatment of scleritis and uveitis for patients with granulomatosis with polyangiitis. Ophthalmic Res. 2019;61(1):44–50.CrossRef Ahmed A, Foster CS. Cyclophosphamide or rituximab treatment of scleritis and uveitis for patients with granulomatosis with polyangiitis. Ophthalmic Res. 2019;61(1):44–50.CrossRef
47.
go back to reference Joshi L, Tanna A, McAdoo SP, Medjeral-Thomas N, Taylor SR, Sandhu G, Tarzi RM, Pusey CD, Lightman S. Long-term outcomes of rituximab therapy in ocular granulomatosis with polyangiitis: impact on localized and nonlocalized disease. Ophthalmology. 2015;122(6):1262–8.CrossRef Joshi L, Tanna A, McAdoo SP, Medjeral-Thomas N, Taylor SR, Sandhu G, Tarzi RM, Pusey CD, Lightman S. Long-term outcomes of rituximab therapy in ocular granulomatosis with polyangiitis: impact on localized and nonlocalized disease. Ophthalmology. 2015;122(6):1262–8.CrossRef
Metadata
Title
Ocular Manifestations of Granulomatosis with Polyangiitis: A Review of the Literature
Authors
Evdokia Sfiniadaki
Ioanna Tsiara
Panagiotis Theodossiadis
Irini Chatziralli
Publication date
01-06-2019
Publisher
Springer Healthcare
Published in
Ophthalmology and Therapy / Issue 2/2019
Print ISSN: 2193-8245
Electronic ISSN: 2193-6528
DOI
https://doi.org/10.1007/s40123-019-0176-8

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