Clinical features and long-term treatment outcome of posterior scleritis

BACKGROUND: To analyze the clinical characteristics and long-term treatment outcomes of patients with posterior scleritis. METHODS: This retrospective, observational case series analyzed medical records of 14 patients diagnosed with infectious or non-infectious posterior scleritis between May 2005 and March 2020 at Severance Hospital and Gangnam Severance Hospital. RESULTS: A total of 12 patients with non-infectious and two with infectious posterior scleritis were treated. Conjunctival injection (85.7%) was the most common symptom, followed by pain on eyeball movement (57.1%), and decreased visual acuity (42.9%). Anterior uveitis (64.3%) was the most common associated clinical finding. In five eyes (35.7%), immunosuppressive agents were administered in addition to corticosteroids to control the inflammation. Recurrence was noted in three eyes (21.4%), all of them showing non-infectious scleritis. The final visual acuity of the patients did not show significant change compared to that at the first visit (P=0.878). CONCLUSIONS: Most posterior scleritis patients were of non-infectious type and some needed additional immunosuppressive treatment. In patients with a history of ocular surgery or trauma, especially with the presence of pus-containing nodules, infectious posterior scleritis should always be considered. Since impaired vision does not improve significantly after treatment of posterior scleritis, prompt diagnosis and aggressive treatment are recommended.