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Caroline Vasseneix, Ghazala O'Keefe, Jessica Shantha, Steven Yeh; Visual morbidity and outcomes in patients with scleritis associated with intraocular inflammation. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6700.
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© ARVO (1962-2015); The Authors (2016-present)
Scleritis may occur secondary to an infectious etiology or in association with systemic autoimmune conditions. The prevalence of intraocular inflammation, spectrum of ocular complications and associated visual morbidity requires better understanding. Herein we evaluate the visual outcomes, complications, and therapies for patients with scleritis associated with intraocular inflammation.
Twenty four patients (36 eyes) with a diagnosis of anterior or posterior scleritis associated with intraocular inflammation, followed for at least 3 months, were retrospectively reviewed. Demographic data, ocular and medical history, infectious or auto-immune systemic diseases associated with scleritis and treatments were recorded. Baseline and interval office visits were assessed for visual acuity (VA), scleritis, disease activity, and anterior and posterior segment complications. We evaluated the visual outcome at final visit, the flare-free time periods and therapies used to treat the inflammation.
Fourteen (58%) patients were women and the mean age was 51 (25-79). Among 36 eyes of 24 patients included, 12 (33%) were classified as anterior scleritis (9 diffuse, 2 nodular, 1 necrotizing), 7 (19%) as posterior scleritis and 5 (14%) as both anterior/posterior scleritis. Anterior uveitis was associated with scleritis at baseline for 17/36 (47%) eyes, panuveitis for 13 (36%) eyes, and intermediate uveitis for 2 (5%) eyes. Eight patients (33%) were diagnosed with a systemic autoimmune disease, 5 (21%) presented with orbital pseudotumor and 2 (8%) had a sclerouveitis due to an HSV infection. At baseline, 12/36 eyes (33%) showed a VA ≤ 20/40. Median follow up was 40 months (IQR 20-81). VA at last visit was ≤20/40 for 16 eyes (44%). Secondary complications included cataract (n=14 patients, 58%), epiretinal membranes or macular changes (n=10, 42%), and choroidal inflammation/scars (n=10, 42%). At last visit, 15 (62.5%) patients required corticosteroid and/or immunomodulating therapy (IMT), with 8 (33%) requiring multiple agents during follow-up, while 9 (37.5%) required no therapy. The median flare-free interval was 4 months (IQR 0-12).
Scleritis with intraocular inflammation was associated with a high rate of visual morbidity and the majority of patients required systemic immunosuppression. Despite multiple immunomodulatory agents, worsening of vision was observed at long-term follow-up.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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