Posterior scleritis - Clinical features, systemic associations, and outcome in a large series of patients

Objective: To document the clinical features, systemic associations, and vi sual outcome in a large number of patients with posterior scleritis. Design: Retrospective, noncomparative case series. Participants: There were 137 patient records showing patients with a diagno sis of posterior scleritis who were attending or had attended the scleritis clinic at Moorfields Eye Hospital between 1974 and 1996. Ninety-nine recor ds were suitable for detailed analysis. Methods: The medical records and B-mode ultrasound examinations were review ed. Main Outcome Measures: The clinical features, systemic associations, treatm ent, and outcome of each patient were determined. Results: Posterior scleritis occurred at all ages. The mean age at onset wa s 49.3 years. Posterior scleritis began before age 40 in 30% of patients an d was twice as common in women as in men. The B-mode ultrasound examination showed diffuse and nodular changes in the posterior sclera, Necrotizing po sterior scleritis was not identified. Twenty-nine percent of patients had a n associated systemic disease that included systemic vasculidites, autoimmu ne diseases, and lymphoma. Such patients more commonly had nodular changes on B-mode ultrasound examination. Early treatment controlled posterior scle ral inflammation and limited visual loss. Thirty-one percent of patients lo st two or more lines of vision. Statistical analysis revealed that patients older than age 50 had an increased risk of having an associated systemic d isease and were more likely to experience visual loss. Patients with associ ated systemic disease required more aggressive immunosuppressive therapy an d more frequently had accompanying anterior scleritis. There was no associa tion between unilateral, bilateral, or recurrent disease and the presence o f systemic disease or visual loss from posterior scleritis. Conclusions: The B-mode ultrasound examination reveals that posterior scler itis occurs far more often than previously thought and can lead to rapid an d permanent visual loss. All patients with posterior scleritis must be assu med to be at risk of visual loss. Forty percent of patients had no anterior scleral inflammation, and 9% had no detectable physical signs. All patient s need to be investigated for an associated systemic disease and all requir e early treatment to minimize loss of vision.