BEN AMOR Hager
To analyze the patterns of posterior scleritis in a referral center in Tunisia
The charts of 29 patients (32 eyes) diagnosed with posterior scleritis were retrospectively reviewed in the Department of Ophthalmology at Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Eleven patients (38%) were male and 62% patients were female. Mean age at presentation was 40.1 years. Clinical findings at presentation included optic disc swelling in 10 eyes (31.2%), retinal striae in 16 eyes (50%), serous retinal detachment (SRD) in 9 eyes (28.1%), and deep yellowish lesions in 6 eyes (18.7%). B-mode ultrasonography showed highly reflective sclero-choroidal thickening in all eyes. Fluorescein angiography showed delayed choroidal perfusion (9 eyes, 37.5%), pin-points (9 eyes, 37.5%), dye pooling (8 eyes, 33.3%), and optic disc hyperfluorescence (21 eyes, 87.5%). Optical coherence tomography showed SRD (11 eyes, 50%) and retinal and/or retinal pigment epithelial folds (16 eyes, 72.7%). Work-up showed that posterior scleritis was associated with systemic disease in 8 patients (27.6%) (rheumatoid arthritis 3 patients, sarcoidosis 1 patient, ankylosing spondylitis 1 patient and unspecified inflammatory arthritis 3 patients) and with tuberculosis in 2 patients (6.9%). A diagnosis of idiopathic posterior scleritis was made in 19 patients (65.5%). The first line therapy included non-steroidal anti-inflammatory drugs in 27 patients (93.1%) and oral corticosteroids in 2 patients (6.9%).
Multimodal imaging provides useful clues for diagnosis of posterior scleritis. A thorough work-up to exclude an underlying infectious or systemic disease is essential for adequate treatment to improve patient outcomes