Clinical features and visual outcomes of the patients with scleritis and episcleritis

Objective To evaluate the clinical characteristics,the associated systemic diseases,the treatment outcomes and prognostic factors of the patients with scleritis and episcleritis.Methods Medical records were retrospectively reviewed for 79 patients with scleritis and episcleritis who presented between 2006 and 2012.Forty-eight patients were female and 31 were male.The mean age at presentation was 47.3±18.7 years old (ranged 16～69 years).The clinical features,the best corrected visual acuity,the systemic disease association,the treatment outcomes and ocular complications were analyzed.The main treatments included the topical or systemic nonsteroidal anti-inflammatory drugs and corticosteroids.Some patients were treated with additional immunosuppressive agents.Results Of the 79 patients,the unilateral involvement occurred in 61 patients (77.2％) and bilateral involvement in 18 patients (22.8％).There was a slight predominance of women (60.8％).There were 11 cases (13.9％) with episcleritis and 68 cases (86.1％) with scleritis.Among the scleritis,there were 37 cases (46.8％) with diffuse anterior scleritis,15 cases (19.0％) with nodular anterior scleritis,4 cases (5.1％) with necrotising anterior scleritis and 12 cases (15.2％) with posterior scleritis.There were 25 cases (31.6％) combined with anterior uveitis,16 cases (20.3％) with ocular hypertension and 23 cases (29.1％) associated with systemic diseases.Thirty-six cases (45.6％) of patients were treated with systemic corticosteroids and 16 cases (20.3％) were combined with immunosuppressive agents.The visual outcomes were generally good in most patients,the risk factors for the poorer visual outcomes included necrotizing scleritis (OR=4.01,P ＜0.01),degree of scleral inflammation of more than level 3 (OR=2.24,P ＜0.01),posterior scleritis (OR=2.13,P ＜0.05),association with systemic disease (OR=1.57,P ＜0.05) and combined with anterior uveitis (OR=1.25,P ＜0.05).Conclusions Scleritis is a form of recurrent ocular inflammation frequently associated with systemic autoimmune diseases.Most of the episcleritis and some anterior scleritis are achieved the good prognostic visual outcomes.Some of the refractory patients need to receive the oral corticosteroids or immunosuppressive drugs to control the recurrent inflammation. Key words: Scleritis; Episcleritis; Immunosuppressive therapy