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Carlos Adolfo Muller Morales, Miguel Pedroza-Seres, Deisy Diarte, Karla Zuñiga; Necrotizing scleritis. Clinical characteristics and ethiology. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2177. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical and epidemiological features, association with systemic disorders and the outcomes in cases of necrotizing scleritis with inflamation.
Retrospective chart review of all patients with infectious scleritis examined from 2007 to 2015 in the Uveitis and Ocular Inmunology Department of Institute of Ophthalmology, “Conde de Valenciana,” Mexico City, Mexico. Information including epidemiological and clinical data were abstracted from the records.
A total of 3122 patients with diagnosis of anterior scleritis were reviewed and only 50 were included. Among them, mean age was 56.38 years (19-85 yo), with sex predominance for woman 58%. Mean time since onset was 11.6 months, with clinical features characterized by hiperemia (92%), ocular pain (82%) and decrease in vision (74%). Average initial visual acuity was .70 ± .63 logMAR (0.00 a 3.00) with 3.54% of the patients worse than 1.3 logMAR. Average final visual acuity .60 ± .83 logMAR (0.00 a 3.00) with 4.54% of the patients worse than 1.3 logMAR. Peripheral ulcerative keratitis with scleritis was observed in 12% and uveitis in 18% of patients. We divided the etiologies in three groups: autoimmune 62%, infectious 20% and idiopathic 18%. Among the autoimmune group we found granulomatosis with polyangitis in 45.16%, rheumatoid arthritis in 38.71%, ankylosing spondylitis 3.2%. For he infectious group we found tuberculosis 60%, herpes simplex 10% and syphilis in 30%. Surgery was practiced in 13 (26%) of the patients; 5 cataract surgery (30%), 3 evisceration (23%), 2 amniotic membrane transplant (2), 1 glaucoma drainage device (7.6%), 1 penetrating keratoplasty (7.6%) and 1 patch and cyanoacrylate glue (7.6%). Within the complications more frequently reported were: cataract 30%, glaucoma 26%, perforation 6%, and painful blind eye 6%.
Necrotizing scleritis represents a clinical and challenge due to its bad prognosis if diagnose or treated wrongly. The ocular findings for our population suggest initial studies for granulomatosis with polyangitis should be performed. Follow up. Early recognition and appropriate treatment improve visual outcome.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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