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A. Anshu, S.P. Chee; Posterior Scleritis and Its Association With HLA B27 Haplotype . Invest. Ophthalmol. Vis. Sci. 2006;47(13):592.
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To document the association between posterior scleritis and HLAB27 in a series of patients who presented with symptoms and signs suggestive of posterior scleritis and were found to be HLAB27 positive.
It is a retrospective review of 5 patients who presented to the Ocular Inflammation and Immunology Service of the Singapore National Eye Centre and were diagnosed to have posterior scleritis. The medical records and ultrasound Bscans were reviewed.
The medical records of 5 patients (4 Chinese and 1 Malay) in the age range of 22 to 64 years were reviewed. All had unilateral disease (4 in the left eye and 1 in the right eye) at presentation. The most common presenting symptoms were pain (5) and blurring of vision (5); diplopia and proptosis was present in 2 patients. 2 patients had anterior scleritis and all had an associated anterior uveitis. Posterior segment findings included optic disc edema (5), macular edema (5), choroidal folds (3), exudative retinal detachement (2) and choroidal effusion (1). All patients had a thickened sclera on serial ultrasound B–scan. 2 patients had joint involvement preceding ocular involvement and were diagnosed to have Ankylosing Spondylitis. HLAB27 haplotype was positive in all our patients. Systemic workup for other diseases was negative. The ocular inflammation responded to a varying combination of topical, periocular and systemic steroids. One of them developed a recurrence of posterior scleritis which resolved with oral steroids. Visual outcome was satisfactory in all but one patient who had RPE atrophy at the macula.
Posterior scleritis in HLAB27 positive patients has rarely been reported. Although posterior scleritis has been reported in association with Ankylosing Spondylitis, it is not clear whether it is the HLAB27 haplotype that is associated with posterior scleritis or Ankylosing Spondylitis. All our patients were HLAB27 positive but only 2 of them had ankylosing spondylitis. This suggests the possible association of posterior scleritis with HLAB27 haplotype. Further studies are however required to confirm its association.
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