Institute Clinic of Ophthalmology, Hospital Clinic of Barcelona, Barcelona, Spain.
Ophthalmology. 2012 Jan;119(1):51-8. doi: 10.1016/j.ophtha.2011.07.043. Epub 2011 Oct 19.
To delineate factors associated with a successful response to treatment in patients with various manifestations of scleritis.
Retrospective case series.
A total of 392 patients with noninfectious anterior scleritis.
We reviewed the electronic health records of 392 patients with noninfectious anterior scleritis seen at 2 tertiary referral centers and studied the factors associated with successful treatment.
Patient characteristics (age, sex); ocular disease characteristics (laterality, type of scleritis, degree of scleral inflammation, ocular complications, delay in presentation, and follow-up period), systemic disease association (associated disease, potentially lethal associated disease); and anti-inflammatory and immunosuppressive medications were studied in patients with scleritis. Successful treatment response to nonsteroidal anti-inflammatory drugs (NSAIDs), steroidal anti-inflammatory drugs (SAIDs), immunosuppressive therapy drugs (immunomodulatory therapy [IMT]), or biologic response modifiers (BRMs) was assessed.
Treatment of 392 patients with noninfectious anterior scleritis included NSAIDs in 144 (36.7%), SAIDs in 29 (7.4%), IMT in 149 (38.0%), BRMs in 56 (14.3%), and none (N = 14). Successful response to treatment with NSAIDs was associated with idiopathic diffuse or nodular scleritis with a low degree of scleral inflammation (≤ 2+) (odds ratio [OR] = 2.89, P < 0.001) and with idiopathic diffuse or nodular scleritis without ocular complications (OR = 3.13, P < 0.001). Successful treatment with SAIDs was associated with idiopathic diffuse or nodular scleritis with a high degree of scleral inflammation (>2+) (OR = 4.70, P = 0.001). Successful treatment with IMT was associated with diffuse or nodular scleritis with associated systemic disease (OR = 1.57, P = 0.047), mainly potentially lethal (OR = 17.41, P=0.007), and necrotizing scleritis (OR = 4.73, P = 0.026). Successful treatment with BRMs was associated with diffuse or nodular scleritis with associated systemic disease (OR = 3.15, P < 0.001). This study did not require institutional review board approval because the information does not contain any subject identifiers.
Patients with idiopathic diffuse or nodular scleritis with a low degree of scleral inflammation or without ocular complications may respond to NSAIDs. Patients with idiopathic diffuse or nodular scleritis with a high degree of scleral inflammation may respond to SAIDs. Patients with diffuse or nodular scleritis with associated systemic disease may respond to IMT or BRMs. Patients with necrotizing scleritis may respond to IMT, mainly alkylating agents.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
明确与各种巩膜炎表现患者治疗反应成功相关的因素。
回顾性病例系列研究。
2 家三级转诊中心共 392 例非感染性前巩膜炎患者。
我们回顾了 392 例非感染性前巩膜炎患者的电子健康记录，并研究了与成功治疗相关的因素。
患者特征（年龄、性别）；眼部疾病特征（单侧、巩膜炎类型、巩膜炎症程度、眼部并发症、就诊延迟和随访期）；全身疾病相关性（伴发疾病、潜在致命伴发疾病）；以及非甾体抗炎药（NSAIDs）、甾体抗炎药（SAIDs）、免疫抑制治疗药物（免疫调节治疗[IMT]）或生物反应调节剂（BRMs）治疗中使用的抗炎和免疫抑制药物。评估了巩膜炎患者对 NSAIDs、SAIDs、IMT、BRMs 或无治疗（N = 14）的治疗反应成功情况。
392 例非感染性前巩膜炎患者的治疗包括 NSAIDs 144 例（36.7%）、SAIDs 29 例（7.4%）、IMT 149 例（38.0%）、BRMs 56 例（14.3%）和无治疗 14 例。NSAIDs 治疗反应成功与特发性弥漫性或结节性巩膜炎、低程度巩膜炎症（≤2+）相关（比值比[OR] = 2.89，P < 0.001），与无眼部并发症的特发性弥漫性或结节性巩膜炎相关（OR = 3.13，P < 0.001）。SAIDs 治疗反应成功与特发性弥漫性或结节性巩膜炎、高程度巩膜炎症（>2+）相关（OR = 4.70，P = 0.001）。IMT 治疗成功与伴全身疾病的弥漫性或结节性巩膜炎相关（OR = 1.57，P = 0.047），主要与潜在致命疾病（OR = 17.41，P=0.007）和坏死性巩膜炎（OR = 4.73，P = 0.026）相关。BRMs 治疗成功与伴全身疾病的弥漫性或结节性巩膜炎相关（OR = 3.15，P < 0.001）。本研究无需机构审查委员会批准，因为所提供的信息不包含任何可识别患者身份的信息。
低程度巩膜炎症或无眼部并发症的特发性弥漫性或结节性巩膜炎患者可能对 NSAIDs 有反应。高程度巩膜炎症的特发性弥漫性或结节性巩膜炎患者可能对 SAIDs 有反应。伴全身疾病的弥漫性或结节性巩膜炎患者可能对 IMT 或 BRMs 有反应。坏死性巩膜炎患者可能对 IMT 有反应，主要是烷化剂。
作者没有与本文讨论的任何材料有关的专有或商业利益。
