Non-Infectious Posterior Scleritis: Clinical Analysis in a Series of 30 Patients

Objective: Summarize the clinical features in posterior scleritis, to provide the basis for correct diagnosis and rational treatment in clinic. Methods: Retrospective interventional case series study. This study included 30 patients (40 eyes), average ± standard deviation age 35.2 ± 14.3 years, who were diagnosed from January 2007 to October 2016 at the Second Affiliated Hospital of Wenzhou Medical University and Zhongshan Ophthalmic Center of Sun Yat-sen University with non-infectious posterior scleritis. The medical history of all cases was documented, and the clinical features were recorded. The examinations included best corrected visual acuity, slit lamp examination, intraocular pressure, B-scan ultrasonography, and other routine eye and auxiliary examinations. Results: Posterior scleritis was unilateral in 20 cases and bilateral in 10 cases at presentation. Thirty-three eyes (83%) were painful and accompanied by vision loss. The visual acuity of 10 eyes (25%) was below 0.1, 13 eyes (32%) were between 0.1 and 0.6, and 17 eyes (43%) were between 0.6 and 1.2. The mean intraocular pressure was 13.2 ± 4.4 mmHg. Eighteen eyes (45%) had anterior uveitis, and 22 eyes (55%) had anterior scleritis. In the posterior segment, 22 eyes (55%) had optic disc swelling, 21 eyes (53%) had retinal phlebectasia, and 13 eyes (33%) had macular exudation detachment. Seven eyes (18%) had exudative retinal detachment, 3 eyes (8%) had macular stellate exudation, 3 eyes (8%) had choroidal detachment, 3 eyes (8%) had central retinal vein occlusion, and 2 eyes (5%) had a retinal or choroidal striae. B-scan ultrasound found increased thickness of the eyeball, with an average of 2.21 ± 0.85 mm. The posterior chamber had an annular hypoechoic with a typical T-sign. Conclusions: Non-infectious posterior scleritis exhibited some features in common with concurrent of anterior uveitis, disc swelling, retinal phlebectasia, macular exudation detachment, and retinal striae. B-scan ultrasound was the most useful diagnostic resource to confirm non-infectious posterior scleritis, with cases having the typical T-sign. Key words: sclera; scleritis; uveitis; clinical features