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Hassan T. Rahman, Sunil Srivastava, Chris Bergstrom, Megan Scott, J. B. Randleman, J. Y. Kim, Jonathan Waltuck, Steven Yeh; Posterior Segment Manifestations of Scleritis: Etiology, Associated Conditions, and Treatment. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2725.
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Posterior segment manifestations of scleritis are likely under-recognized and may contribute to visual morbidity. We characterize a series of patients with scleritis and posterior segment disease.
Retrospective, interventional consecutive case series of patients with scleritis and posterior segment disease. Records were reviewed for visual acuity, etiology and type of scleritis, posterior segment manifestations, associated systemic diagnoses, and need for steroid-sparing immunosuppression.
12 patients with both scleritis and posterior segment disease were identified from a database of uveitis patients from a tertiary referral center. Scleritis classifications included diffuse anterior (50%), nodular anterior (25%), posterior (17%) and scleromalacia perforans (8%). Systemic disease associations were identified in 50% of patients and included chronic demyelinating inflammatory polyneuropathy, rheumatoid arthritis, and relapsing polychondritis. Posterior manifestations and associated ocular conditions (# of eyes) included exudative RD (2), subretinal and/or choroidal granulomas (4), disc edema (1), panuveitis (3), retinal vasculitis (2), orbital pseudotumor (1), anterior uveitis (1), central serous retinopathy (1), and VMT/ERM (1). 83% of eyes (15/18) maintained or improved vision >/=2 lines during follow-up. 3 eyes lost >/= 2-lines of vision, including 1 eye that progressed to NLP. The mean follow-up period was 7.5 months. 92% of patients required systemic corticosteroid, and 83% required steroid-sparing immunosuppression including MTX, mycophenolate, azathioprine, rituximab, and adalimumab. 25% of patients required 2 or more steroid-sparing agents.
Posterior segment disease in patients presenting with scleritis may result in significant visual morbidity. The majority of these patients require steroid-sparing immunosuppression to stabilize inflammation and prevent visual loss.
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