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H. Salehi-had, P. Caruso, G. Papaliodis; Utility of MRI as an Imaging Modality in Posterior Scleritis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3901.
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Posterior scleritis is an elusive diagnosis. B-scan ultrasonography is a useful tool, but it is not always diagnostic. With advances in the imaging technology, MRI may be a useful adjunct and a more sensitive diagnostic imaging modality. We reviewed cases of posterior scleritis to evaluate weather there were any diagnostic signs evident on the MRI.
Retrospective analysis of all cases of posterior scleritis from one uveitis specialist at the Massachusetts Eye and Ear Infirmary that underwent both MRI and B-scan ultrasonography.
Two cases of posterior scleritis were identified that fit the inclusion criteria. Each case had over one year of follow up with a complete ophthalmic and systemic evaluation. Case 1 was a 12-year-old previously healthy girl who presented with 4 weeks of photophobia, decreased vision, and eye pain worse on eye movement. Her initial exam revealed a best corrected visual acuity of 20/200 OD and 20/400 OS, 1+ bulbar conjunctival/episcleral injection, and bilateral disc edema. B-scan ultrasound revealed fluid in the subtenon’s space (T-sign) and thickening of the sclera. On MRI, axial T1 weighted post-gadolinium images showed thickening and enhancement of the uveoscleral margin, OS greater than OD. Case 2 was a 37-year-old woman who presented with 2 weeks of photopsia, one day of pain in her left brow, and "few dark spots" in her field of vision in each eye. On initial exam she had a visual acuity of 20/25 OD and 20/30 OS, trace bulbar conjunctival/episcleral injection, trace cell in the anterior chamber, and multifocal serous retinal detachments with disc hyperemia OS greater than OD. B-scan ultrasonography revealed no T-sign. Fluorescein angiography (FA) revealed mottled choroidal filling and areas of early punctate hyperfluorescence with late staining. On MRI, axial T1 weighted post-gadolinium fat saturation images demonstrated increased enhancement along the epibulbar/episcleral margin of the left globe with bilateral, asymmetric thickening of the sclera and enhancement of the uvea. Based on clinical presentation and ancillary testing, both patients were diagnosed with posterior scleritis. They have not had any associated systemic disorders to date. No nodular focus was seen on MRI in either case and the adjacent orbital fat and optic nerve appeared normal suggesting a limited disease of the sclera and the uvea.
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