title: Visual outcome, treatment results, and prognostic factors in patients with scleritis.
abstract: OBJECTIVE
  To analyze the visual outcome, systemic associations, effectiveness of treatment, and predicting features of 104 scleritis patients.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  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.
  
  
  METHODS
  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 α (TNF-α) 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-α antagonists can be used in case of MTX failure. Tumor necrosis factor α 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.
authors.affiliation: Department of Ophthalmology, Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. w.wieringa@umcg.nl
authors.forename: Wietse G
authors.initials: WG
authors.lastname: Wieringa
authors.forename: Jaap E
authors.initials: JE
authors.lastname: Wieringa
authors.forename: Ninette H
authors.initials: NH
authors.lastname: ten Dam-van Loon
authors.forename: Leonoor I
authors.initials: LI
authors.lastname: Los
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D015423:Scleritis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D009173:Mycophenolic Acid; D008727:Methotrexate