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C. Foster, V. Fiorelli, P. Bhat; Recurrent Anterior Scleritis Treated with Non-steroidal Anti-inflammatory or Systemic Immunomodulatory Therapy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2696.
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Scleritis is a severe inflammatory condition and without treatment, may become progressively destructive, leading to vision loss or loss of the eye. We present a study comparing the use of prophylactic oral non steroidal anti inflammatory drugs (NSAIDs) and systemic immunomodulatory therapy (IMT) in the prevention of recurrent attacks of inflammation in patients with anterior scleritis.
Retrospective case-series. Medical records of 38 patients with a diagnosis of anterior scleritis who had been treated with either NSAIDs or IMT were included in the study. Patients with simple, diffuse, or nodular scleritis, and no associated life-threatening systemic disease, were treated with systemic NSAIDs. Patients with scleritis associated with connective tissue or collagen vascular diseases, with a potential for lethal complications, were treated with systemic IMT. Data concerning NSAIDs and IMT, time in remission, recurrences, side effects and systemic diseases were collected. Remission was defined as no inflammation while on therapy.Mann-Whitney test was used to compare follow up, time in remission and relapses between NSAID and IMT groups. A p value of less than 0.05 was considered to be of statistical significance.
The average follow-up time in the NSAID group (n=19) was 19.1± 6.0 months with time in remission while on treatment with NSAIDs was 16.0± 5.8 months. The average number of relapses while on NSAID therapy was 0.74. The NSAIDs used were celecoxib (n=7) and diflunisal (n=12). The average follow-up time in the IMT group (n=19) was 19.1± 6.6 months with time in remission while on treatment with IMT was 13.2± 5.9 months. The average number of relapses while on IMT was 1.31. Patients in the NSAID group remained in remission longer and had a lower relapse rate compared to the IMT group. However, these differences between the 2 groups were not found to be statistically significant (p=0.36 and p=0.11 respectively).
Our results stress the importance of carefully selecting therapy for each patient based on presence of associated systemic illness. Some patients with scleritis with serious systemic conditions may not respond to NSAIDs and may require IMT therapy.
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