Clinical Profile of Patients with Posterior Scleritis: 14 Cases Report

FU Bo; XU Li

doi:10.3969/j.issn.1672-7185.2019.03.019

Abstract：Objective? To summarize the clinical features and treatments of patients with posterior scleritis. Methods The clinical data of 14 patients with posterior scleritis (18 eyes), which were collected from the Fourth People’s Hospital of Shenyang between January 2016 and May 2018 were retrospectively reviewed. The medical history, clinical features, clinical examination, intraocular pressure (IOP), B-scan ultrasound, fundus photography, optical coherence tomography (OCT), ocular wall thickness measurement, fundus fluorescein angiography (FFA), and the best corrected visual acuity (BCVA) were compared between before and after treatment. Results The thirteen patients with diffuse posterior scleritis received glucocorticoid treatment, and the patents with complication received symptomatic therapy. One patient with nodular type were treated with ophthalmectomy in other hospital. The visual acuity before treatments were from light perception to 0.5 The Ocular pain occurred in 11 patients, redness in 5 patients, 1 patient had eyelid swelling, and 4 patients complained of headache. The patients with monocular posterior scleritis account for 71.4%, and RF (+) in one case. There were 5 eyes with conjunctival congestion, 3 eyes with anterior chamber flares[IOP: (15.02±3.25)mmHg], 6 eyes with optic disc edema, 1 eye with star-shaped macular exudates, 7 eyes with retina/choroidal folds and 7 eyes with retinal pigment epithelium detachment, and 1 eye with retinal tubercle. B scan ultrasound demonstrated that the ocular walls were thickening in 16 eyes and 14 eyes were with typical T-sign. The average thickness was (2.72±0.69) mm. After 6 months treatment, one case with nodular type changed into granuloma type. BVCA was 0.1~0.8 after treatmet in 13 patients with diffuse type, and improved significantly. The inflammation of anterior segment subsided, IOP was (15.03±2.36)mmHg, and ocular hypertension occurred in two patients. The edema of optic disc significantly subsided, the fluid under retina was absorded, and star-shaped macular exudates were significantly attenuated. The B-ultrasound showed that eyeball edema subsided and T-sign disappeared. The ocular wall thickness significantly decreased to (1.51±0.48 )mm,. Compared with parameters before the treatments, the difference was statistically significant (t=0.032, P＜0.05). The FFA examination showed that the fluorescein leakages of the disc and retina were disappeared and edema of optic disc were significantly attenuated. Conclusion The clinical manifestations of posterior scleritis was complicated. Some patients have anterior segment signs, and most patients showed a typical "T" shape sign under B scan ultrasound. Systemic glucocorticoid therapy can effectively release the symptoms of posterior scleritis patients. A suitable, individually treatment should be chosen to achieve better prognosis.