Abstract
Purpose: :
To examine the presentation and treatment of scleritis at Northwestern Univ. Ophthalmology Dept. and compare results to literature.
Methods: :
IRB approved retrospective chart review of patients diagnosed with anterior scleritis, necrotizing scleritis, nodular scleritis, or scleromalacia perforans between 3/2008 and 5/2010.
Results: :
Of 43 patients (53 eyes), mean presenting age was 54 years (range 24-78 years). 10 patients had bilateral disease at presentation. Follow up ranged from initial visit to 2 years. Females comprised 72% of patients. Visual acuity at presentation ranged from 20/20 to LP in a pre-phthisical eye. 60% of eyes had visual acuity from 20/25 to 20/30. Redness and pain were the most common presenting symptoms, followed by photophobia and headache. Scleral injection was observed in all cases. Anterior chamber inflammation was noted in 4 eyes (7.5%). 22 patients (44%) presented with known systemic inflammatory disease with rheumatoid arthritis (RA) being the most common (25.5 %, n=11). 24 patients (55.8%) had a work up performed. 14 of these 24 (58%) had no preexisting autoimmune disease. 7 out of these 24 (29%) had positive results, leading to newly diagnosed disease in 3 (12.5%). Of the remaining 4 patients, 3 had positive results of unknown significance and 1 had known RA. The most common initial treatment (n=13) was oral non-steroidal anti-inflammatory drugs (NSAIDs) alone, followed by a combination of oral NSAIDs and topical steroids (n=8). 5 of 13 patients (38%) failed oral NSAIDs but responded to oral steroids or immunosuppressive therapy. Immunosuppressive drugs including methotrexate (MTX), mycophenolate mofetil, cyclophosphamide, adalimumab, and leflunomide were used in 12 patients (27.9%). MTX was the most commonly initiated immunosuppressive drug (66.7%, n=8). MTX failed in 3 out of the 8 patients, and 1 could not tolerate the side effects; 2 patients were switched to mycophenolate mofetil, 1 to adalimumab and leflunomide, and 1 to adalimumab. 4 patients treated with a subconjunctival triamcinolone injection were tapered off oral steroids--2 continued on MTX and 2 on mycophenolate mofetil.
Conclusions: :
Newly diagnosed autoimmune disease from a work up (12.5%) was comparable to the literature. Systemic autoimmune disease was present in half of our patients, slightly above other studies, and RA was the most common. In patients who failed NSAIDs and required oral steroids, immunosuppressive drugs with or without subconjunctival triamcinolone injection played an important role in long-term disease control.
Keywords: autoimmune disease • sclera