Abstract
Purpose :
To assess the risk factors and outcomes of surgical interventions in scleritis patients in the IRIS® Registry (Intelligent Research in Sight).
Methods :
Retrospective cohort study of IRIS Registry scleritis patients (N=111,324) requiring surgical intervention (scleral reinforcement, keratoplasty, corneal or scleral laceration repair, or globe removal) between 2013 and 2019. We assessed demographic risk factors for surgical intervention, perioperative therapeutic management, visual outcomes and need for subsequent surgical procedures.
Results :
643 of 111,324 scleritis patients (0.6%, 675 eyes) required a surgical procedure, with scleral reinforcement being the most common (348 patients, 373 eyes). Patients requiring scleral reinforcement (66.5 ± 15.3 years, p<0.001), keratoplasty (61.2 ± 16.9 years, p=0.04), laceration repair (63.6 ± 17.9 years, p=0.03) or globe removal (63.0 ± 15.0, p=0.02) were on average older than patients who did not require surgery (58.5 ± 16.6 years). Male sex was more common in patients undergoing scleral reinforcement, keratoplasty and globe removal (p < 0.006). Active and former smoking was a risk factor for scleral reinforcement, keratoplasty and laceration repair (p < 0.004). At the time of surgery, most eyes were not treated with systemic immunosuppressive therapy (565 eyes, 84%). A minority received a local corticosteroid injection (triamcinolone, dexamethasone or dexamethasone implant) within 30 days of surgery (0.7%). Post-operative mean logMAR acuity improved by 6 months for eyes that underwent scleral reinforcement (0.2 logMAR improvement, p=0.009) and keratoplasty (0.7 logMAR improvement, p < 0.001) but not for laceration repair; however, 6 month post-operative acuities were overall poor (mean 0.7-1.6 logMAR depending on procedure). Mean preoperative visual acuity was worse in patients on systemic immunosuppressive medications prior to scleral reinforcement (p = 0.03) with persistently poor mean acuity following surgery. Repeat surgical intervention occurred in 80 eyes (11.8%).
Conclusions :
Older age, male sex, and smoking are risk factors for surgical intervention in scleritis patients. Use of perioperative corticosteroid sparing immunosuppressive medications was uncommon. Improvement in vision occurred after scleral reinforcement and keratoplasty procedures, although on average visual acuity remained substantially decreased.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.