title: Posterior scleritis: clinical features, systemic associations, and outcome in a large series of patients.
abstract: OBJECTIVE
  To document the clinical features, systemic associations, and visual outcome in a large number of patients with posterior scleritis.
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  There were 137 patient records showing patients with a diagnosis of posterior scleritis who were attending or had attended the scleritis clinic at Moorfields Eye Hospital between 1974 and 1996. Ninety-nine records were suitable for detailed analysis.
  
  
  METHODS
  The medical records and B-mode ultrasound examinations were reviewed.
  
  
  METHODS
  The clinical features, systemic associations, treatment, and outcome of each patient were determined.
  
  
  RESULTS
  Posterior scleritis occurred at all ages. The mean age at onset was 49.3 years. Posterior scleritis began before age 40 in 30% of patients and was twice as common in women as in men. The B-mode ultrasound examination showed diffuse and nodular changes in the posterior sclera. Necrotizing posterior scleritis was not identified. Twenty-nine percent of patients had an associated systemic disease that included systemic vasculidites, autoimmune diseases, and lymphoma. Such patients more commonly had nodular changes on B-mode ultrasound examination. Early treatment controlled posterior scleral inflammation and limited visual loss. Thirty-one percent of patients lost two or more lines of vision. Statistical analysis revealed that patients older than age 50 had an increased risk of having an associated systemic disease and were more likely to experience visual loss. Patients with associated systemic disease required more aggressive immunosuppressive therapy and more frequently had accompanying anterior scleritis. There was no association between unilateral, bilateral, or recurrent disease and the presence of systemic disease or visual loss from posterior scleritis.
  
  
  CONCLUSIONS
  The B-mode ultrasound examination reveals that posterior scleritis occurs far more often than previously thought and can lead to rapid and permanent visual loss. All patients with posterior scleritis must be assumed to be at risk of visual loss. Forty percent of patients had no anterior scleral inflammation, and 9% had no detectable physical signs. All patients need to be investigated for an associated systemic disease and all require early treatment to minimize loss of vision.
authors.affiliation: Department of Clinical Ophthalmology, Institute of Ophthalmology and Moorfields Eye Hospital, London, England.
authors.forename: P J
authors.initials: PJ
authors.lastname: McCluskey
authors.forename: P G
authors.initials: PG
authors.lastname: Watson
authors.forename: S
authors.initials: S
authors.lastname: Lightman
authors.forename: J
authors.initials: J
authors.lastname: Haybittle
authors.forename: M
authors.initials: M
authors.lastname: Restori
authors.forename: M
authors.initials: M
authors.lastname: Branley
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012590:Sclera / Q000000981:diagnostic imaging; D015423:Scleritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D008775:Methylprednisolone