Clinical analysis of 12 posterior scleritis patients with an initial symptom of affected optic nerve / 中华眼底病杂志

ABSTRACT

Objective To summarize the clinical features and visual outcome of posterior scleritis presented with symptoms involving affected optic nerve.Methods Retrospective case series study.Twelve eyes of 12 female patients with posterior scleritis were included in this study.The average age was 35.2± 14.31 years old.The patients got diagnosed with an average of 24.75 ± 22.91 days.Ocular pain was complained in all patients,and blurred vision in 11 patients.The best corrected visual acuity (BCVA),intraocular pressure (IOP),slit lamp microscope examination,B-scan ultrasound,optical coherence tomography (OCT),fundus photography,fundus fluorescein angiography (FFA) and ocular wall thickness measurement were performed in all patients.Nine eyes received visual field examination.All patients received systemic corticosteroid and steroidal eye drops for 3 months.Clinical features and outcome were retrospectively studied.Results Before treatment,the BCVA was from ＜0.1 to ＞0.8.There were 3 eyes with scleral hyperemia,3 eyes with anterior chamber flares,12 eyes with papilledema and different degrees of retinal vein dilatation,3 eyes with star-shaped macular exudates and 2 eyes with macular retinal pigment epithelium detachment.B-scan ultrasound demonstrated that the ocular walls were thickening in all eyes with typical T-sign,and the average thickness was 2.76± 0.68 mm.OCT demonstrated optic disc swelling,and the macular retinal detachment in 2 eyes.In the FFA examination,the fluorescein leakage of the disc was enhanced with time.In the Humphrey test,the value of mean deviation (MD) was 12.56± 5.73 dB and pattern standard deviation (PSD) was 8.15±4.23 dB in 9 eyes before the treatment.After treatment for 3 months,the symptoms were attenuated and the visual acuity was obviously improved with BCVA＞0.1 in all eyes.Scleral hyperemia and anterior chamber flares were only found in 1 eye.The optic disc edema gradually faded away.The ocular wall thickness in the poster part of the eyeball decreased,and the T-sign disappeared in all eyes,the average thickness was 1.53±0.41 mm.Compared with parameters before the treatment,the difference was statistically significant (t=0.003 5,P＜0.05).OCT demonstrated the recovery of the macular retinal detachment.There was no abnormal leakage evidenced in FFA in the optic disc and macular.After treatment,the value of MD and PSD was 5.19±4.82 dB and (4.33 ±3.76) dB,respectively.The difference of MD value between before and after the treatment was significant (t=0.026,P＜0.05).Conclusions Posterior scleritis with an initial symptom of optic nerve was tend to affect middle-aged patients,with clinical manifestations of anterior segment signs in some patients and optic disc swelling with retinal vein dilatation in all patients.B ultrasound examination showed typical T sign.Systemic corticosteroid treatment always obtained remission of the ocular inflammatory activity,and could achieve favorable visual outcome.