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Julie L Morrison, Ethan Nguyen, Jessica Brennan, Richard Stawell, Lyndell L Lim, Peter J McCluskey; Scleritis in Australia: Disease Associations and Ocular Complications. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2513.
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Scleritis is a rare ocular inflammatory condition which has the potential for significant visual loss. This retrospective review looks at the demographics, clinical features and complications associated with infectious and non-infectious scleritis in an Australian population.
Retrospective chart review of 90 patients with scleritis from three Australian tertiary referral centers from 1988 to 2013. Data collected included type of scleritis, demographics, ocular complications, associated systemic disease and treatments.
The mean age of onset was 50 years of age (range 8 to 85). Females accounted for 62% of presentations and had an earlier mean age of onset (46 vs. 57, p=0.01).Nine of the 90 subjects had infectious scleritis (tuberculosis n=3, herpes zoster ophthalmicus n=2, other n=4). Of the non-infectious scleritis, the commonest form was diffuse (45%), followed by nodular (23%), necrotising (16%) and posterior (16%). The majority of cases (75%) were unilateral, with diffuse scleritis being more likely to be bilateral than other types (39%,p=0.008). Forty percent were found to have an associated systemic disease, with diffuse anterior scleritis the most likely to be associated with systemic disease than any other type of scleritis (45%). The most commonly associated systemic disease was rheumatoid arthritis (RA, n=9, 29%), followed by Wegener’s granulomatosis (n=5, 16%). Those with RA were more likely to have bilateral involvement (56%, p=0.037). Necrotising disease was more likely than non-necrotising disease to have associated corneal involvement (p=0.019), cataract (p=0019) and keratitis (p=0.032). Those with posterior involvement were more likely to have reduced visual acuity (p=0.010), due to its higher association with uveal effusion (p=0.012), macular edema (p=0.028) and retinal detachment (p<0.001).
This is the first study to categorize an Australian population of scleritis patients. Consistent with previous studies, we found females were more likely to suffer from scleritis and present at a younger age. Necrotizing scleritis or scleritis with posterior involvement were more likely to be associated with ocular complications. A higher proportion of posterior scleritis was identified compared to previous studies.
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