The Short-Term Outcome of Treatment with Corticosteroids and Immunosuppressive Drugs for Non-Infectious Posterior Scleritis

Abstract

Objective: To explore the short-term clinical outcome of treatment with corticosteroids and immunosuppressive drugs for non-infectious posterior scleritis. Methods: Twenty patients (20 eyes) who were diagnosed with posterior scleritis from January 2012 to October 2017 in the Department Ophthalmology of the Second Affiliated Hospital of Wenzhou Medical University were recruited for this retrospective series of case study. Clinical findings were documented before and after treatment for all patients. Patients also underwent testing for best corrected visual acuity, intraocular pressure, fundus examination, and posterior retinal examination with B-scan ultrasound. Examinations were performed at 1 week, 2 weeks, 1 month, 3 months and 6 months after the start of treatment. All results were quantitatively and statistically analyzed by variance analysis. Results: Before treatment, 18 patients (90%) had complained about pain and worsening vision, 13 patients had anterior uveitis and anterior scleritis, 17 eyes had optic disc swelling, and 18 eyes had retinal phlebectasia. After two weeks of treatment, 18 patients (90%) had relief from pain symptoms and 7 patients (35%) had improved visual acuity. Anterior inflammation eased in all patients after 1 month of treatment. Optic disc edema and retinal phlebectasia were alleviated in 10 eyes, the retinal/choroidal folds gradually resolved, and symptoms were eased in all cases after 3 months of treatment. Almost all abnormalities in the fundus disappeared after 6 months of treatment. After treatment, B-scan ultrasound examination showed that eyeball thickness was reduced and accompanied by "T" syndrome remission, with an average of 2.82±0.63 mm, 2.01±0.68 mm, 1.86±0.44 mm, 1.68±0.45 mm, and 1.43±0.65 mm after treatment for 1 week, 2 weeks, 1 month, 3 months and 6 months, respectively, compared to 3.24±0.78 mm before treatment. Compared to pre-treatment, the difference from 2 weeks after treatment was statistically significant (t=13.76, P=0.0017). Symptoms were alleviated in about 17 cases after two weeks of treatment with an effective rate of 30% (6 cases). Effectiveness was at 45% (9 cases) after 3 months of treatment, and 5 patients (25%) were cured. Conclusions: Aggressive therapy with systemic corticosteroids and immunosuppressive agents to treat posterior scleritis always achieves good resolution in a short period of time with a favorable visual outcome but long-term therapy is often required to prevent recurrence. B-scan ultrasound is the most useful option for assessing the therapeutic effect during follow-up. Key words: sclera; posterior scleritis; clinical treatment; uveitis