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S. Ahn, J. Oh, M. Kim, W. Wee; Clinical features and treatment outcomes of scleritis in Korean population. Invest. Ophthalmol. Vis. Sci. 2009;50(13):288.
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To determine associated factors and clinical features of scleritis in Korean population and to evaluate the treatment outcome by subtype.
Medical records of scleritis patients seen at Seoul National University Hospital between Jan 2005 and April 2008 were reviewed. Clinical characteristics including associated systemic disease, microorganism, and surgical history were inspected and compared by subtype. The treatment outcome including visual acuities before and after treatment was also evaluated in each subtype.
Sixteen of 76 patients had scleritis in both eyes. The average age was 58.7 years (range 11-81), and 53 (76%) were female. The subtype of scleritis was most commonly nodular (28, 36%), followed by necrotizing with inflammation (22, 28%), diffuse (19, 26%), and necrotizing without inflammation (6, 7.8%). 11 (14.2%) of 76 cases were infectious. Seven (9,2%) of 76 patients had connective tissue diseases such as systemic lupus erythematosus (2), rheumatoid arthritis (2), Wegener’s granulomatosis (1), ankylosing spondylitis (1), and Behcet’s disease (1). Associated serologic markers included FANA (8), ANCA (4), HLA-B27 (2), and rheumatoid factor (1). These serologic markers were frequently associated with diffuse scleritis. The most prevalent microorganism associated with scleritis was fungus (6, 55%), followed by bacteria (4, 36%). Aspergillus species (3, 27%) were most frequently identified. Thirty two patients (42.1%) had previous ocular surgery, most frequently pterygium excision (28, 36.8%). All 11 patients with infectious scleritis had surgical history of pterygium excision. Twenty five (89.3%) of 28 patients who had pterygium excision had necrotizing scleritis. Visual acuities before and after the treatment were worst in necrotizing scleritis, followed by infectious, diffuse, and nodular.
Ocular surgery, especially pterygium excision, is the most important factor affecting scleritis in Korean population. Infectious and necrotizing scleritis demonstrated poor visual prognosis and remarkable association with pterygium excision. The microbiology evaluation needs to be performed in patients with necrotizing scleritis.
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