The clinical features of posterior scleritis with serous retinal detachment: A retrospective clinical analysis

Abstract

Objective: To summarize the clinical features, systemic associations, risk factors and choroidal thickness(CT) changing in posterior scleritis (PS) with serous retinal detachment. Methods: This retrospective study included 23 patients with PS with retinal detachment from August 2012 to July 2017. All patients were documented with the Medical history and clinical features were recorded. The examinations included best corrected visual acuity (BACV), intraocular pressure（IOP）, fundus examination, routine eye examinations. Posterior coats thickness (PCT) was determined by B scan Ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). And clinical data were compiled and analyzed. Results: After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5 ± 9.24 years old. Ocular pain and blurred vision were the two most common symptoms complained by patients. Anterior scleritis occurred in 12 patients, which was confirmed by Ultrasound Biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no fluorescein leakage was observed in the macular. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT increased with fluid in Tenon’s capsule demonstrated as a typical T-sign. The average PCT was 2.51 ± 0.85 mm in the PS-affected eye and only 1.09 ± 0.29 mm in the unaffected eye; this difference reached statistical significance. The subfoveal CT increased to an average of 442.61 ± 55.61μm, which correlated with axis length and PCT, but not with IOP. The BCVA and IOP did not correlate with either CT or the PCT. Conclusions: PS with serous retinal detachment presented with a variety of symptoms, such as pain and visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound was a useful confirmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inflammation.

A Solitary Choroidal Mass with Spontaneous Resolution

“…Even rare, nodular posterior scleritis has been reported [5] and can be considered as another possible diagnosis. Although sudden onset, loss of vision, SRD [5], and findings Case Reports in Ophthalmological Medicine in FA (a localized starry sky appearance) and ICGA (hypofluorescent dark dots present up to the intermediate phase of angiography) [6] are compatible with the diagnosis but contrary to our case, majority of posterior scleritis patients present with ocular pain (78%) and edema in Tenon space ("T" sign in ultrasonography), and only 13% of patients exhibit subretinal localized granuloma [7][8][9]. To our knowledge, there is no report of spontaneous resolution of nodular posterior scleritis without any treatment.…”

Clinical features and long-term treatment outcome of posterior scleritis

“…Diagnosis of posterior scleritis is sometimes challenging. Funduscopic or OCT findings involving the posterior segment, such as choroidal effusion and detachment, and cystoid macular edema, are helpful in the diagnosis (8,14,15); however, we encountered three patients who did not show abnormal funduscopic findings. B-scan ultrasonography was of diagnostic value in all patients, particularly in these three patients who showed no abnormalities on funduscopic examination.…”