Visual Outcome, Treatment Results, and Prognostic Factors in Patients with Scleritis

Purpose: To analyze the visual outcome, systemic associations, effectiveness of treatment, and predicting features of 104 scleritis patients. Design: Retrospective case series. Participants: One hundred four patients treated for scleritis at the University Medical Centers of Groningen and Utrecht, The Netherlands. Methods: The clinical records of 104 patients diagnosed with scleritis between 1992 and 2011 at the University Medical Centers of Groningen (n = 64) and of Utrecht (n = 40) were analyzed retrospectively. Main Outcome Measures: Loss of visual acuity, ocular complications, related systemic disease, type of treatment, time to treatment success, and predictive features. Results: Mean age +/- standard deviation (SD) was 51.5 +/- 13.6 years, and 63 (60.6 %) patients were female. Mean follow-up +/- SD was 38.2 +/- 33.8 months. A loss of more than 2 lines of Snellen acuity was observed in 23 patients, 3 of whom had a final visual acuity of no light perception. In general, patients with necrotizing scleritis (n = 15) had a poorer outcome. Ocular complications were observed in 88 (84.6%) patients. Underlying systemic disease was identified in 34 (32.7%) patients. Steroid-sparing immunosuppressive medication was used in 47 patients, 36 of whom were treated with methotrexate (MTX). This treatment was successful in 17 (47.2%) patients over the course of a mean +/- SD of 103.7 +/- 83.7 weeks. Mycophenolate mofetil was the treatment in 10 patients, and in 5 of these patients, treatment success was achieved in a mean +/- SD of 65.3 +/- 37.4 weeks. Treatment with tumor necrosis factor alpha (TNF-alpha) antagonists led to treatment success in a mean +/- SD of 32.6 +/- 21.8 weeks in 5 of the 11 treated patients. Patients with loss of visual acuity or those treated with steroid-sparing immunosuppressive drugs more often had an underlying associated disease, bilateral scleritis, and a longer duration of symptoms at presentation. Conclusions: Scleritis is a severe ocular inflammatory disease often associated with ocular complications. In this population, roughly half of the patients were treated with systemic immunosuppressive medication. Mycophenolate mofetil and TNF-alpha antagonists can be used in case of MTX failure. Tumor necrosis factor alpha antagonists seemed to be more effective than MTX. Within this group, an underlying associated disease, bilateral scleritis, and a longer duration of symptoms at presentation were predictive features for a more severe disease course. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2013;120:379-386 (C) 2013 by the American Academy of Ophthalmology.