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Tellioğlu A, Yargı Özkoçak B, Kemer Atik B, Başarır B, Altan C. Clinical Features, Treatment, and Visual Outcomes of Posterior Scleritis from Tertiary Eye Care Center. Ocul Immunol Inflamm 2023:1-7. [PMID: 37549312 DOI: 10.1080/09273948.2023.2241556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/01/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE To describe the epidemiological and clinical features and course of patients with posterior scleritis (PS). METHODS This retrospective, cross-sectional consecutive case series analyzed the medical records of 16 patients diagnosed with PS. RESULTS Female gender and unilateral involvement were dominant. Blurred vision (84.21%) and ocular pain (78.95%) were the most common presenting complaints. Serous retinal detachment was the most common ocular finding (84.21%), followed by optic disc swelling (42.11%). Increased scleral thickness was observed in all patients, although a T-sign was detected 8 of 19 eyes (42.1%). Recurrence occured in 5 of 19 eyes in mean 30.2 ± 34.7 months. Central macular thickness, choroidal thickness, and retinal nerve fiber layer thickness were reduced with treatment at final examination significantly (p = .005, .002, and .002, respectively). CONCLUSIONS PS should be considered in patients presenting with unilateral ocular pain and decreased vision. Not only USG findings but also OCT findings are very useful in the follow-up of treatment response.
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Affiliation(s)
- Adem Tellioğlu
- Department of Ophtalmology, Soma State Hospital, Manisa, Turkiye
| | - Berru Yargı Özkoçak
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Burcu Kemer Atik
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Berna Başarır
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Altan
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Chen B, Yang S, Zhu L, Peng X, He D, Tao T, Su W. Adalimumab plus Conventional Therapy versus Conventional Therapy in Refractory Non-Infectious Scleritis. J Clin Med 2022; 11:jcm11226686. [PMID: 36431163 PMCID: PMC9697705 DOI: 10.3390/jcm11226686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Long-term systemic glucocorticoids and non-specific immunosuppressants remain the mainstay of treatment for refractory scleritis, and result in serious side-effects and repeated inflammation flares. To assess the efficacy and safety of additional adalimumab, patients diagnosed with refractory non-infectious scleritis were enrolled. They were assigned to the conventional-therapy (CT, using systemic glucocorticoids and other immunosuppressants) group or the adalimumab-plus-conventional-therapy (ACT) group according to the treatments they received. The primary outcome was time to achieve sustained remission, assessed by a reduction in modified McCluskey's scleritis scores. Other outcomes included changes in McCluskey's scores, scleritis flares, best-corrected visual acuity, and spared glucocorticoid dosage. Patients in the ACT group achieved faster remission than those in the CT group, as the median periods before remission were 4 months vs. 2.5 months (p = 0.016). Scleritis flares occurred in 11/11 eyes in the CT group and 5/12 eyes in the ACT group (p = 0.005). Successful glucocorticoid sparing was realized in both groups, but the ACT group made it faster. No severe adverse events were observed. Data suggest that adalimumab plus conventional therapy could shorten the time to remission, reduce disease flares, and accelerate glucocorticoid withdrawal compared with conventional therapy alone.
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Affiliation(s)
- Binyao Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Shizhao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Lei Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xuening Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Daquan He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Tianyu Tao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Correspondence: (T.T.); (W.S.)
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
- Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
- Correspondence: (T.T.); (W.S.)
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Pan Y, Chen YX, Lu Y, Xie YY, Xia YW, Liang D. Outcomes of Escalating Immunosuppressive Treatments for Recalcitrant Noninfectious Posterior Scleritis. Ophthalmol Ther 2022; 11:2297-2307. [PMID: 36224311 DOI: 10.1007/s40123-022-00577-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION This article aimed to summarize the outcomes of escalating immunosuppressive treatments for patients with recalcitrant noninfectious posterior scleritis (PS). METHODS Clinical records of 16 patients diagnosed with recalcitrant noninfectious PS in the Ocular Immunity and Uveitis Department of Zhongshan Ophthalmic Center from September 2016 to December 2021 were reviewed. Patients were treated with escalating immunosuppressive regimen including corticosteroid, immunosuppressants (IMTs), and adalimumab (ADA). Demographic characteristics and clinical findings at each visit were recorded. The doses of prednisone were analyzed. Main outcomes were corticosteroid-sparing effects, control of inflammation, visual acuity, and safety profile. RESULTS Ocular pain was the most common finding (100%), followed by the T sign on the B scan (93.8%) and associated anterior scleritis (75.0%). The average initial dose of prednisone was 25.0 mg/day, and tapered to 11.3 and 5.0 mg/day at month 1 and 3, respectively, with statistical significance (p < 0.05). The median overall periods of prednisone tapering to 10, 5, and 0 mg/day were 1.0, 3.0, and 3.0 months, respectively. There were 93.8% of patients receiving prednisone ≤ 10 mg/day and 68.8% of patients off prednisone at last visit. There were 80% of patients treated with IMT and ADA off prednisone at last visit, reaching the highest percentage compared with others. A best-corrected visual acuity of 1.0 or better at last visit was achieved in 10 eyes (62.5%). The escalating treatments showed good safety profile. CONCLUSION Patients of recalcitrant noninfectious PS benefited from escalating immunosuppressive treatments with favorable visual outcome, in which methotrexate, ciclosporin, and ADA were preferred with good safety.
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Affiliation(s)
- Yuan Pan
- Department of Ocular Immunology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, No. 54 Xianlie South Road, Guangzhou, 510060, China
| | - Yu-Xi Chen
- Department of Ocular Immunology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, No. 54 Xianlie South Road, Guangzhou, 510060, China
| | - Yao Lu
- Department of Ocular Immunology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, No. 54 Xianlie South Road, Guangzhou, 510060, China
| | - Yan-Yan Xie
- Department of Ocular Immunology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, No. 54 Xianlie South Road, Guangzhou, 510060, China
| | - Yi-Wen Xia
- Department of Ocular Immunology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, No. 54 Xianlie South Road, Guangzhou, 510060, China
| | - Dan Liang
- Department of Ocular Immunology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, No. 54 Xianlie South Road, Guangzhou, 510060, China.
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Hong CM, Shin MH, Kim SJ, Seo SW, Chung I, Yoo WS. Bilateral posterior scleritis after sequential bilateral cataract surgery: a case report. BMC Ophthalmol 2022; 22:321. [PMID: 35883109 PMCID: PMC9321295 DOI: 10.1186/s12886-022-02537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Posterior scleritis is a rare, inflammatory ophthalmic disease, leading to severe visual impairment if untreated. Posterior scleritis occurring after surgery, unrelated to systemic inflammatory diseases, is even rarer. This report discusses a case of bilateral posterior scleritis, after cataract surgery in both the eyes, treated with high-dose steroids. Case presentation A 55-year-old man, who had undergone bilateral sequential cataract surgery one week before, presented with sudden loss of vision and ocular pain in both eyes. The patient had no systemic diseases or neurological symptoms. Serous retinal detachment of the macula with optic disc swelling was observed on fundus examination in both the eyes, and bilateral thickening of choroid and sclera was seen in ultrasonography. Under diagnosis of bilateral posterior scleritis due to the increased signal of sclera in both the eyes on magnetic resonance imaging, high-dose steroid therapy was performed. After treatment, improvement in visual acuity and retinal detachment were observed, and thereafter, it has been maintained without relapse. Conclusions With high-dose steroid therapy, we successfully treated a rare case of bilateral posterior scleritis following cataract surgery in both eyes. To our knowledge, this is the first report on posterior scleritis occurring after surgery, unrelated to systemic inflammatory diseases.
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Affiliation(s)
- Chae-Min Hong
- Department of Ophthalmology, College of Medicine, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea.,Department of Ophthalmology, Gyeongsang National University Hospital, Gangnam-ro 79, Gyeongnam, Jinju, South Korea
| | - Min-Ho Shin
- Department of Ophthalmology, College of Medicine, Chosun University, Gwangju, South Korea
| | - Seong-Jae Kim
- Department of Ophthalmology, College of Medicine, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea.,Department of Ophthalmology, Gyeongsang National University Hospital, Gangnam-ro 79, Gyeongnam, Jinju, South Korea.,Institute of Health Sciences, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea
| | - Seong-Wook Seo
- Department of Ophthalmology, College of Medicine, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea.,Department of Ophthalmology, Gyeongsang National University Hospital, Gangnam-ro 79, Gyeongnam, Jinju, South Korea.,Institute of Health Sciences, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea
| | - Inyoung Chung
- Department of Ophthalmology, College of Medicine, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea. .,Department of Ophthalmology, Gyeongsang National University Hospital, Gangnam-ro 79, Gyeongnam, Jinju, South Korea. .,Institute of Health Sciences, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea.
| | - Woong-Sun Yoo
- Department of Ophthalmology, College of Medicine, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea. .,Department of Ophthalmology, Gyeongsang National University Hospital, Gangnam-ro 79, Gyeongnam, Jinju, South Korea. .,Institute of Health Sciences, Gyeongsang National University, Gangnam-ro 79, Gyeongnam, Jinju, South Korea.
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Berkenstock MK, Long K, Miller JB, Burkholder BB, Aucott JN, Jabs DA. Scleritis in Lyme Disease. Am J Ophthalmol 2022; 241:139-144. [PMID: 35513033 DOI: 10.1016/j.ajo.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate the incidence of scleritis in Lyme disease and report clinical features. DESIGN Incidence rate estimate and case series. METHODS Data were collected from an electronic medical record on patients with scleritis presenting to the Wilmer Eye Institute between January 1, 2012 and December 31, 2020. A diagnosis of Lyme disease was made using the Infectious Diseases Society of America, American Academy of Neurology, and the American College of Rheumatology 2020 joint criteria plus a response to antibiotic therapy. After identifying all new-onset cases of scleritis in the database, the proportion of new-onset scleritis with Lyme disease was calculated. The proportion of Lyme disease cases with scleritis was estimated using the number of cases with Lyme disease from the Baltimore metropolitan area reported to the Centers for Disease Control and Prevention. After querying other major eye centers in the area for any cases of Lyme disease scleritis, none were identified, and the incidence of Lyme disease scleritis was estimated using published U.S. Census data for the greater Baltimore metropolitan area. RESULTS Six cases of Lyme disease scleritis were identified in the 8-year time frame; 1 additional case was identified in the following year. Lyme disease scleritis accounted for 0.6% of all cases of scleritis, and 0.052% of patients with Lyme disease had scleritis. The estimated incidence of Lyme scleritis was 0.2 per 1,000,000 population per year (95% confidence interval 0-0.4), whereas the estimated incidence of Lyme disease in the area was 3 per 10,000 population per year (95% confidence interval 2.9-3.1). All scleritis cases were anterior, unilateral, without necrosis, and resolved with antibiotic use without relapse in a median of 39.5 days (range 29-57 days). Other features of Lyme disease were present in 4 of 7 patients, including a history of erythema migrans in 2 of 7 patients. CONCLUSIONS Lyme disease is an uncommon cause of scleritis in endemic areas.
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Vermeirsch S, Testi I, Pavesio C. Choroidal involvement in non-infectious posterior scleritis. J Ophthalmic Inflamm Infect 2021; 11:41. [PMID: 34705127 PMCID: PMC8554953 DOI: 10.1186/s12348-021-00269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose To provide a comprehensive overview of choroidal involvement in non-infectious posterior scleritis; including different imaging modalities and their clinical usefulness. Methods Narrative review. Results Posterior scleritis is an uncommon yet potentially sight-threatening inflammation of the sclera. During the disease process, inflammation can spread to the adjacent choroid, causing different manifestations of choroidal involvement: (1) increased choroidal thickness, (2) choroidal vasculitis, (3) presentation as a choroidal or subretinal mass in nodular posterior scleritis, and (4) choroidal folds, choroidal effusion and exudative retinal detachment. Conclusions Clinical characteristics and multimodal imaging can aid in diagnosing and monitoring disease progression and response to treatment in non-infectious posterior scleritis with choroidal involvement.
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Affiliation(s)
- Sandra Vermeirsch
- Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK
| | - Ilaria Testi
- Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK.
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Comparison of the clinical features between posterior scleritis with exudative retinal detachment and Vogt-Koyanagi-Harada disease. Int Ophthalmol 2021; 42:479-488. [PMID: 34623571 DOI: 10.1007/s10792-021-02064-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/21/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This study aims to analyse the differences in clinical characteristics between VKH disease and PS with exudative retinal detachment (ERD). METHODS The medical records of 18 eyes of 12 patients with PS accompanied by ERD and 32 eyes of 16 patients with VKH disease were retrospectively reviewed. RESULTS Single ERD was more common in PS, while hyperreflective dots, multiple ERD, retinal pigment epithelium folds were more common in VKH disease on OCT. Both posterior coat thickness and choroid thickness were higher in VKH eyes. "T" sign was observed in 6 of 18 eyes (33.3%) in the PS group, whereas in none of the eyes of VKH disease. No significant differences were shown in FA imaging between PS and VKH cases. Relapse occurred in 12 eyes (66.7%) in PS group, mainly in the posterior segment, while 6 eyes (18.8%) experienced recurrence in the anterior segment in VKH group. CONCLUSION There are characteristic differences in multimodal imaging parameters and clinical course between VKH and PS with ERD.
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Kalogeropoulos D, Katsikatsos K, Mitsis M, Kalogeropoulos C. Posterior Scleritis as a Paraneoplastic Syndrome in Colon Cancer: A Case Report. Turk J Ophthalmol 2021; 50:377-380. [PMID: 33389939 PMCID: PMC7802099 DOI: 10.4274/tjo.galenos.2020.99836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study presents a rare case of unilateral posterior scleritis as an ophthalmic manifestation of a paraneoplastic syndrome. A 61-year-old man presented to our department complaining of gradual worsening of vision in his left eye. Visual acuity was 10/10 and 3/10 in his right and left eye, respectively. He also mentioned that he experienced posterior ocular pain while sleeping at night, but was otherwise asymptomatic. His past ophthalmic and medical history were clear. A thorough clinical, imaging (fundus photography, optical coherence tomography, fluorescein angiography, and B-scan), and laboratory investigation was carried out. A diagnosis of posterior scleritis was made, but no obvious cause or underlying disease was identified even after a thorough systematic assessment. Regular follow-up within the next few months did not reveal any further pathological findings. Finally, 6 months after the initial presentation, the patient was diagnosed with colon cancer. Posterior scleritis can present as an ophthalmic manifestation of a paraneoplastic syndrome in patients with an underlying malignancy, even months before the presentation of systemic symptoms and diagnosis of the underlying disease. In conclusion, in patients (especially older adults) with posterior scleritis, the possibility of a malignant neoplasia must not be ignored or underestimated (paraneoplastic syndrome).
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Affiliation(s)
- Dimitrios Kalogeropoulos
- University of Ioannina School of Health Sciences Faculty of Medicine, Department of Ophthalmology, Ioannina, Greece
| | - Konstantinos Katsikatsos
- University of Ioannina School of Health Sciences Faculty of Medicine, Department of Ophthalmology, Ioannina, Greece
| | - Michail Mitsis
- University of Ioannina School of Health Sciences Faculty of Medicine, Department of Surgery, Ioannina, Greece
| | - Chris Kalogeropoulos
- University of Ioannina School of Health Sciences Faculty of Medicine, Department of Ophthalmology, Ioannina, Greece
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Wen C, Duan H. Bilateral posterior scleritis presenting as acute primary angle closure: A case report. World J Clin Cases 2021; 9:3779-3786. [PMID: 34046483 PMCID: PMC8130077 DOI: 10.12998/wjcc.v9.i15.3779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Scleritis is a rare disease and the incidence of bilateral posterior scleritis is even rarer. Unfortunately, misdiagnosis of the latter is common due to its insidious onset, atypical symptoms, and varied manifestations. We report here a case of bilateral posterior scleritis that presented with acute eye pain and intraocular hypertension, and was initially misdiagnosed as acute primary angle closure. Expanding the literature on such cases will not only increase physicians' awareness but also help to improve accurate diagnosis. CASE SUMMARY A 53-year-old man was referred to our hospital to address a 4-d history of bilateral acute eye pain, headache, and loss of vision, after initial presentation to a local hospital 3 d prior. Our initial examination revealed bilateral cornea edema accompanied by a shallow anterior chamber and visual acuity reduction, with left-eye amblyopia (> 30 years). There was bilateral hypertension (by intraocular pressure: 28 mmHg in right, 34 mmHg in left) and normal fundi. Accordingly, acute primary angle closure was diagnosed. Miotics and ocular hypotensive drugs were prescribed, but the symptoms continued to worsen over the 3-d treatment course. Further imaging examinations (i.e., anterior segment photography and ultrasonography) indicated a diagnosis of bilateral posterior scleritis. Methylprednisolone, topical atropine, and steroid eye drops were prescribed along with intraocular pressure-lowering agents. Subsequent optical coherence tomography (OCT) showed gradual improvements in subretinal fluid under the sensory retina, thickened sclera, and ciliary body detachment. CONCLUSION Bilateral posterior scleritis can lead to secondary acute angle closure. Diagnosis requires ophthalmic accessory examinations (i.e., ultrasound biomicroscopy, B-scan, and OCT).
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Affiliation(s)
- Chao Wen
- Department of Anesthesia, The First Affiliated Hospital of Dalian Medical University, Dalian 116001, Liaoning Province, China
| | - Hui Duan
- Department of Ophthalmology, The First Affiliated Hospital of Dalian Medical University, Dalian 116001, Liaoning Province, China
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Dutta Majumder P, Agrawal R, McCluskey P, Biswas J. Current Approach for the Diagnosis and Management of Noninfective Scleritis. Asia Pac J Ophthalmol (Phila) 2020; 10:212-223. [PMID: 33290287 DOI: 10.1097/apo.0000000000000341] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT Scleritis is a rare, vision-threatening inflammation of the sclera that is often associated with life-threatening systemic illnesses. Rheumatoid arthritis remains the most common associated systemic rheumatic disease and the commonest systemic association of scleritis. Granulomatosis with polyangiitis is the most common cause of vasculitis-associated scleritis. The etiopathogenesis of scleritis remains unclear, but can be immune complex-mediated or due to a local delayed hypersensitivity reaction. Scleritis can involve either the anterior or posterior sclera, and has a wide spectrum of clinical presentations. Among the subtypes of scleritis, necrotizing scleritis has an increased risk of complications and is more commonly associated with anterior uveitis and peripheral ulcerative keratitis. Posterior scleritis is often not diagnosed or missed due to its subtle clinical signs and protean manifestations. Meticulous history taking, detailed ocular examination, and a targeted array of investigations with a multi-disciplinary approach to find any underlying systemic disease are crucial for the management of a case of scleritis. Corticosteroids remain the mainstay of short-term treatment of scleritis; mild to moderate scleral inflammation may respond well to treatment with nonsteroidal antiinflammatory drug or topical corticosteroid. Corticosteroid-sparing immunosuppressive therapies are useful in cases with an inadequate response or failure to provide long-term control of inflammation, and to prevent recurrence of scleritis. Biologic agents are increasingly used in the management of scleritis, not responding to the conventional therapies. This review provides an overview of the various subtypes of scleritis and its systemic associations and evaluates current trends in the diagnosis and management of noninfective scleritis.
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Affiliation(s)
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Peter McCluskey
- Ocular Infections and Antimicrobials Research Group, Singapore Eye Research Institute, Singapore
| | - Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, India
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Belenje A, Rani PK. A rare case of bilateral sequential posterior scleritis in an elderly woman. BMJ Case Rep 2020; 13:13/9/e235702. [PMID: 32900729 DOI: 10.1136/bcr-2020-235702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old woman came with complaints of decreased vision and minimal pain on extraocular movements in the left eye and, after investigations, was diagnosed with posterior scleritis. Systemic steroid treatment helped resolve the symptoms and signs. One year later, she presented with right eye involvement. She was evaluated for systemic illness and, based on clinical and investigational findings, it was deduced that probably a sarcoidosis was predisposing her to the eye problem. She was provisionally diagnosed with bilateral sequential posterior scleritis secondary to sarcoidosis. She was prescribed oral steroids, which helped resolve her eye problem. She was next referred to a rheumatologist and a pulmonologist for further evaluation and treatment.
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Affiliation(s)
- Akash Belenje
- Smt Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telengana, India
| | - Padmaja Kumari Rani
- Smt Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telengana, India
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Kumar A, Ghose A, Biswas J, Majumder PD. Clinical profile of patients with posterior scleritis: A report from Eastern India. Indian J Ophthalmol 2018; 66:1109-1112. [PMID: 30038152 PMCID: PMC6080445 DOI: 10.4103/ijo.ijo_121_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: This study aimed to report the clinical profile of patients with posterior scleritis at a tertiary eye center in Eastern India. Methods: This was a single-center retrospective case series of patients who were diagnosed as posterior scleritis between January 2010 and December 2014, with a follow-up period of at least 6 months. Results: The study included 18 patients of posterior scleritis with a mean age of 41.2 ± 10.6 years (range: 26–63 years). With female preponderance (55.6%), majority of the posterior scleritis cases were unilateral (88.9%). Sixteen patients reported with diminution of vision, eleven patients (61.1%) had ocular pain on presentation, and five patients complained of headache. Concurrent anterior scleritis was found in three eyes (15%) with posterior scleritis. Choroidal folds and subretinal fluid at the posterior pole were the most common fundus findings and were seen in seven eyes (35%) each. No systemic association was detected in any patient even after extensive laboratory workup and multidisciplinary consultation. All patients received oral steroid, and 11 (61.1%) of them required intravenous pulse steroid therapy. Immunosuppressive was used in 6 (33.3%) patients, and oral azathioprine was the most common immunosuppressive used in the study. Recurrence was noted in eight eyes (40%). The mean best-corrected visual acuity improved to logarithm of the minimal angle of resolution (logMAR) 0.06 ± 0.051 at the final follow-up from 0.47 ± 0.45 logMAR at presentation (P = 0.00608). Conclusion: Posterior scleritis is relatively rare but can occur without systemic involvement. Aggressive immunomodulatory therapy is required to treat vision-threatening condition.
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Affiliation(s)
- Amitabh Kumar
- Department of Uvea, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Avirupa Ghose
- Department of Uvea, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
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Murugan SB. Commentary: Posterior scleritis: Nuances to discern and handle effectively! Indian J Ophthalmol 2018; 66:1113-1114. [PMID: 30038153 PMCID: PMC6080434 DOI: 10.4103/ijo.ijo_639_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- S Bala Murugan
- Uveitis Services, Aravind Eye Hospital, Puducherry, India
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14
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Lane J, Nyugen E, Morrison J, Lim L, Stawell R, Hodgson L, Bin Ismail MA, Ling HS, Teoh S, Agrawal R, Mahendradas P, Hari P, Gowda PB, Kawali A, McCluskey PJ. Clinical Features of Scleritis Across the Asia-Pacific Region. Ocul Immunol Inflamm 2018; 27:920-926. [DOI: 10.1080/09273948.2018.1484496] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Joshua Lane
- Ophthalmology Department, Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ethan Nyugen
- Ophthalmology Department, Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Julie Morrison
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Lyndell Lim
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Stawell
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren Hodgson
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ho Su Ling
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Stephen Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | - Parvathi Hari
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | | | - Ankush Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Peter J. McCluskey
- Ophthalmology Department, Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia
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15
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Hodge C, Sutton G, Devasahayam R, Georges P, Treloggen J, Cooper S, Petsoglou C. The use of donor scleral patch in ophthalmic surgery. Cell Tissue Bank 2016; 18:119-128. [DOI: 10.1007/s10561-016-9603-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/17/2016] [Indexed: 12/17/2022]
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16
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17
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Affiliation(s)
- Emmett T. Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA,
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA,
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA,
| | - Peter McCluskey
- Save Sight Institute, Sydney Medical School, University of Sydney, NSW, Australia,
| | - Carlos Pavesio
- Moorfields Eye Hospital and Biomedical Research Centre, NHS Foundation Trust, London, UK,
| | - Denis Wakefield
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, New South Wales, Australia, and
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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