Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.
Ophthalmology. 2012 Jan;119(1):59-65. doi: 10.1016/j.ophtha.2011.09.030. Epub 2011 Dec 3.
To summarize the clinical findings and treatment response in posterior scleritis affecting children and to compare these features with posterior scleritis affecting adults.
Retrospective interventional case series.
Twenty eyes of 13 patients aged younger than 18 years who were diagnosed with posterior scleritis in a tertiary referral center.
Investigations and treatment were according to standard care, following published recommendations for scleritis.
Clinical features, investigation results, treatment received, and visual outcome were studied.
Twenty eyes of 13 patients (aged 5-16 years, median 11.53 years; 8 female, 5 male) were included. Scleritis was unilateral in 6 cases and bilateral in 7 cases at presentation. The median presenting vision was 20/30. All eyes had T-sign demonstrable on B-scan ultrasound. Concurrent anterior segment signs included anterior uveitis (80.0%) and anterior scleritis (20.0%). Posterior segment signs included optic disc swelling (95.0%) and retinal striae (85.0%). No underlying connective tissue disorder was diagnosed in any patient. Scleritis resolved with oral nonsteroidal anti-inflammatory agent alone in 1 patient (8%). Twelve patients (92.3%) received oral corticosteroid. Immunosuppressive agents were required in 11 patients (84.6%) because of relapse or intolerance to corticosteroid. The median final vision at 1 year was 20/20. Seven patients (63.6%) remained on immunosuppression at latest follow-up (median 4 years).
Common features of posterior scleritis include concurrent anterior uveitis, disc swelling, and retinal striae. B-scan ultrasound demonstrating T-sign was the most useful confirmatory investigation in all cases. Systemic association is uncommon. Aggressive therapy with systemic corticosteroid achieves resolution mostly within the first year. Long-term immunosuppression is often required to prevent recurrence. Visual outcome is favorable.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
总结儿童后巩膜炎的临床发现和治疗反应，并将这些特征与成人后巩膜炎进行比较。
回顾性干预性病例系列研究。
在一家三级转诊中心诊断为后巩膜炎的 13 例年龄小于 18 岁的患者的 20 只眼。
根据标准护理进行检查和治疗，遵循发布的巩膜炎治疗建议。
研究临床特征、检查结果、治疗方法和视力结果。
纳入 13 例（5-16 岁，中位数 11.53 岁；8 名女性，5 名男性）20 只眼。发病时单侧巩膜炎 6 例，双侧巩膜炎 7 例。中位首发视力为 20/30。所有眼的 B 超均显示 T 征。同时存在前节体征，包括前葡萄膜炎（80.0%）和前巩膜炎（20.0%）。后节体征包括视盘肿胀（95.0%）和视网膜条纹（85.0%）。在任何患者中均未诊断出潜在的结缔组织疾病。1 例（8.0%）患者仅接受口服非甾体抗炎药治疗后炎症消退。12 例（92.3%）患者接受口服皮质类固醇治疗。11 例（84.6%）患者因对皮质类固醇不耐受或复发而需要免疫抑制剂治疗。1 年后的中位最终视力为 20/20。7 例（63.6%）患者在最近的随访（中位 4 年）时仍在接受免疫抑制治疗。
后巩膜炎的共同特征包括同时存在前葡萄膜炎、视盘肿胀和视网膜条纹。所有病例中，B 超显示 T 征是最有用的确诊检查。全身关联不常见。全身性皮质类固醇治疗可在第一年大部分时间内缓解炎症。为防止复发，常需长期免疫抑制治疗。视力预后良好。
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