Journal d'ophtalmologie clinique et expérimentale
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Assessment of Uveitis and Complications by Ultrasound in Comparison with Optical Coherence Tomography in Psoriatic Arthritis using Etanercept

Jose Alexandre Mendonca, Vanessa Felix Nascimento Coelho, Heitor Santos Nogueira, Livia Garcia Biselli, Luciana Bertoldi Nucci

Introduction: Ocular Ultrasonography (US) can be an important dynamic method in evaluating the inflammatory process of the vitreous humor and its complications in patients with arthritis.

Objectives: To detect uveal changes as well as complications by B-mode US and compare them with Optical Coherence Tomography (OCT) in a patient with Psoriatic Arthritis (PsA) using a soluble anti-Tumor Necrosis Factor (TNF) receptor.

Case presentation: This clinical case included a 64-year-old Caucasian female patient diagnosed with PsA. The patient reported that her visual acuity worsened 3 years ago, with tearing, a sensation of sand, ocular pain, with redness, bilaterally, using methotrexate and etanercept for 18 months. Biometry was used for ophthalmological clinical assessment, US with a 12 MHz high-frequency linear probe for semi-quantitative assessment of 0 to 3 vitreous echoes by Gray Scale (GS), changes in the thickness of the optic nerve sheath and structural damage to the retina by OCT.

Results: The patient presented biometry and US with total detachment of the left vitreous, along with grade 3 changes in vitreous echo by the GS, complications, such as detachment of the vitreous humor and changes in thickening of the optic nerve sheath, with mean 5.5 mm bilaterally. The OCT showed worse retinal thinning on the left in the foveal region, characterized by a decrease in central macular thickness of 212 μm, the presence of a hyper-reflective space at the level of the photoreceptor layer, suggestive of their rupture and worsening of vision.

Conclusion: US detected significant vitritis and complications, seen by GS and confirmed by OCT, through retinal structural damage. Thus, it demonstrated that a fusion protein of the human tumor necrosis factor p75 Fc receptor should also not be indicated for patients with a chronic inflammatory process in the posterior chamber.