Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.
Ophthalmology. 2012 Jan;119(1):43-50. doi: 10.1016/j.ophtha.2011.07.013. Epub 2011 Oct 2.
To evaluate the demographic characteristics, clinical features, ocular complications, and disease associations of patients with scleritis and episcleritis; as well as to delineate the risk factors for decreased vision in patients with scleritis.
Retrospective case series.
Five hundred patients with scleritis and 85 patients with episcleritis.
The electronic health records of 500 patients with scleritis and 85 patients with episcleritis seen at 2 tertiary referral centers were reviewed and their clinical features were studied.
Clinical features (pain, scleral inflammation), ocular complications (decrease in vision, anterior uveitis, peripheral ulcerative keratitis, ocular hypertension), and disease associations.
In a series of 585 patients, 500 patients had scleritis (85.5%) and 85 patients had episcleritis (14.2%). Ocular complications were more frequent overall in patients with scleritis versus in those with episcleritis (45.0% vs. 19.0%), including decrease in vision (15.8% vs. 2.3%), anterior uveitis (26.4% vs. 16.5%), peripheral ulcerative keratitis (7.4% vs. 0%), and ocular hypertension (14.2% vs. 3.5%; P<0.0001 for each). Disease association was observed in 35.8% of patients with scleritis versus 27.1% of episcleritis patients, including connective tissue or vasculitic diseases in 24.8% versus 15.3%, respectively. Scleritis preceded systemic disease diagnosis in 38.7% of patients. Ocular complications (90.0%) and disease association (80.0%) occurred most often in patients with necrotizing scleritis (P<0.0001 for each). Risk factors for decrease in vision in patients with scleritis included necrotizing scleritis (odds ratio [OR], 6.63; P<0.001), posterior scleritis (OR, 2.33; P = 0.042), degree of scleral inflammation of more than 2+ (range, 0-4+; OR, 3.60; P<0.001), anterior uveitis (OR, 1.78; P = 0.033), ocular hypertension (OR, 3.19; P<0.001), and associated disease (OR, 2.66; P<0.001), mainly infectious (OR, 4.44; P<0.001).
Scleritis is associated more often with ocular complications than episcleritis, and necrotizing scleritis is the type of scleritis most often associated with ocular complications and disease association. Risk factors for decrease in vision in patients with scleritis include necrotizing scleritis, posterior scleritis, scleral inflammation of more than 2+, anterior uveitis, ocular hypertension, and associated infectious disease.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
评估巩膜炎和表层巩膜炎患者的人口统计学特征、临床特征、眼部并发症和疾病关联；并阐明巩膜炎患者视力下降的危险因素。
回顾性病例系列。
在 2 家三级转诊中心就诊的 500 例巩膜炎患者和 85 例表层巩膜炎患者。
回顾性分析了在 2 家三级转诊中心就诊的 500 例巩膜炎患者和 85 例表层巩膜炎患者的电子健康记录，并研究了他们的临床特征。
临床特征（疼痛、巩膜炎症）、眼部并发症（视力下降、前葡萄膜炎、周边溃疡性角膜炎、眼压升高）和疾病关联。
在 585 例患者中，500 例（85.5%）患有巩膜炎，85 例（14.2%）患有表层巩膜炎。与表层巩膜炎相比，巩膜炎患者的眼部并发症更为常见（45.0% vs. 19.0%），包括视力下降（15.8% vs. 2.3%）、前葡萄膜炎（26.4% vs. 16.5%）、周边溃疡性角膜炎（7.4% vs. 0%）和眼压升高（14.2% vs. 3.5%；P<0.0001）。在巩膜炎患者中，有 35.8%存在疾病关联，而表层巩膜炎患者为 27.1%，其中结缔组织或血管炎分别为 24.8%和 15.3%。38.7%的巩膜炎患者在出现眼部并发症之前就已经确诊了系统性疾病。在坏死性巩膜炎患者中，眼部并发症（90.0%）和疾病关联（80.0%）最为常见（P<0.0001）。巩膜炎患者视力下降的危险因素包括坏死性巩膜炎（比值比 [OR]，6.63；P<0.001）、后巩膜炎（OR，2.33；P = 0.042）、巩膜炎症程度超过 2+（范围 0-4+；OR，3.60；P<0.001）、前葡萄膜炎（OR，1.78；P = 0.033）、眼压升高（OR，3.19；P<0.001）和合并疾病（OR，2.66；P<0.001），主要为感染性疾病（OR，4.44；P<0.001）。
巩膜炎比表层巩膜炎更常伴有眼部并发症，坏死性巩膜炎是最常伴有眼部并发症和疾病关联的巩膜炎类型。巩膜炎患者视力下降的危险因素包括坏死性巩膜炎、后巩膜炎、巩膜炎症程度超过 2+、前葡萄膜炎、眼压升高和合并感染性疾病。
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