Laghmari M, Boutimzine N, Karim A, Alami Moudni M, Benchrif M Z, Essakalli H N, Mohcine Z
Service d'Ophtalmologie A, Hôpital des Spécialités, Rabat, Maroc.
J Fr Ophtalmol. 2004 Feb;27(2):174-8. doi: 10.1016/s0181-5512(04)96115-3.
Posterior scleritis is a rare but probably underdiagnosed process. The lesions may cause diagnostic confusion with other diseases such as intraocular tumors and orbital or cerebral involvement. In the case presented, posterior scleritis simulated acute posterior multifocal placoid pigment epitheliopathy.
A 43-year-old woman presented with a history of pain and eye redness with lid swelling in the left eye followed by visual deterioration. On fundus examination, there was disc and macular edema with multiple grayish-white placoid and deep chorioretinal lesions in the posterior pole. Fluorescein angiography was compatible with acute posterior multifocal placoid pigment epitheliopathy, but the inflammatory context was unusual in this disorder. An orbital computed tomographic scan and b-scan ultrasonography showed posterior scleral thickening and the diagnosis of posterior scleritis was made. Etiological investigations were negative. A pulse of corticosteroids was started and the patient's symptoms and signs improved on clinical and angiographic examination.
Posterior scleritis may present with a range of clinical findings. Its clinical features may simulate many other diagnoses such as acute posterior multifocal placoid pigment epitheliopathy. Management is different in each situation: abstention in acute posterior multifocal placoid pigment epitheliopathy and a high dose of corticosteroids or even immunosuppressive therapy in posterior scleritis.
This report shows that posterior scleritis must be evoked in patients with unilateral fundus appearance of acute posterior multifocal placoid pigment epitheliopathy associated with an inflammatory context. Ultrasonography or MRI must be carried out.
后巩膜炎是一种罕见但可能未被充分诊断的病症。这些病变可能会与其他疾病如眼内肿瘤以及眼眶或脑部病变相混淆，从而造成诊断困难。在本文所呈现的病例中，后巩膜炎酷似急性后极部多灶性鳞状色素上皮病变。
一名43岁女性，有左眼疼痛、眼红伴眼睑肿胀病史，随后视力下降。眼底检查发现视盘和黄斑水肿，后极部有多个灰白色鳞状及深层脉络膜视网膜病变。荧光素血管造影结果与急性后极部多灶性鳞状色素上皮病变相符，但该病症的炎症背景并不常见。眼眶计算机断层扫描和B超检查显示后巩膜增厚，从而确诊为后巩膜炎。病因学检查结果为阴性。开始给予冲击剂量的皮质类固醇治疗，患者的症状和体征在临床及血管造影检查中均有所改善。
后巩膜炎可能呈现出一系列临床症状。其临床特征可能与许多其他诊断相类似，如急性后极部多灶性鳞状色素上皮病变。每种情况的治疗方法不同：急性后极部多灶性鳞状色素上皮病变一般无需治疗，而后巩膜炎则需要大剂量皮质类固醇甚至免疫抑制治疗。
本报告表明，对于单侧眼底表现为急性后极部多灶性鳞状色素上皮病变且伴有炎症背景的患者，必须考虑后巩膜炎的可能性。必须进行超声检查或磁共振成像检查。
