Abstract
Purpose :
Necrotizing scleritis represents the most severe form of anterior scleritis and can result in scleral perforation, requiring surgical management. We evaluated the clinical course of patients with necrotizing scleritis to determine risk factors for perforation.
Methods :
Retrospective study of 35 patients (70 eyes) seen by the physicians of the Department of Ocular Immunology and Uveitis at the Wilmer Eye Institute from January 2006 to September 2022. Data collected demographic information, immunosuppressive medications and doses, whether perforation occurred, and surgical management.
Results :
Median age at presentation was 69 years; 57% of patients were male. Caucasians comprised 63% of patients and the median duration of ocular symptoms prior to presentation was 4 months. Infectious scleritis was diagnosed in 6 patients (17%). A systemic illness was present in 18 patients (51%), with the most prevalent being an ANCA associated vasculitis followed by rheumatoid arthritis. Of the 70 eyes examined at baseline, 39 (57%) had scleral thinning at presentation, and 4 eyes (6%) had perforated prior to perforation. During follow-up 2 eyes perforated in a median time of 10 days from presentation. Surgical management consisted of three repeated patch grafts in one eye and no surgery performed in the other eye. At the time of perforation both patients were on oral prednisone at a median dose of 47.5 mg. Only one of the patients was on systemic immunosuppressant medication (100 mg/daily oral Cytoxan). In patients who experienced perforation in at least one eye prior to presentation or during follow-up, 33% (N=2) had an underlying systemic illness.
Conclusions :
The percent of patients with necrotizing scleritis requiring surgical management decreases with aggressive initiation of prednisone with combination immunosuppressive therapy. Infectious scleritis is common and must be appropriately ruled out and treated prior to beginning immunosuppressive therapy. Long term immunosuppressive therapy is especially useful to reduce the risk for perforation, especially in those with an underlying autoimmune disorder.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.