Rao N A, Marak G E, Hidayat A A
Ophthalmology. 1985 Nov;92(11):1542-9.
Scleritis is not a single clinical or pathologic entity. It has several distinct forms. A clinico-pathologic study of 41 cases of necrotizing scleritis suggests that these different histopathologic forms of disease may reflect different mechanisms of immunopathogenesis. These cases were divided into three main groups: (1) scleral inflammations associated with various systemic autoimmune diseases, including 11 cases of rheumatoid arthritis, three cases of Wegener's granulomatosis, one case of polychondritis, and one case of Goodpasture's syndrome; (2) infectious scleritis, consisting of four cases of herpes zoster ophthalmicus and two cases of pseudomonas scleritis; and (3) idiopathic scleritis, without evidence of systematic disorder, consisting of 19 cases. The first group exhibited predominantly necrosis of the sclera surrounded by granulomatous inflammation and vasculitis. None of these cases showed lymphoid follicles, or healing attempts manifested by proliferation of fibroblasts and blood vessels at the site of inflammation. The idiopathic group revealed few small foci of scleral necrosis and mainly non-granulomatous inflammation. In addition, there was evidence of proliferation of granulation tissue and lymphoid follicles in this group of eyes.
巩膜炎并非单一的临床或病理实体。它有几种不同的形式。一项对41例坏死性巩膜炎的临床病理研究表明，这些不同的疾病组织病理学形式可能反映了免疫发病机制的不同。这些病例分为三个主要组：（1）与各种全身性自身免疫性疾病相关的巩膜炎症，包括11例类风湿性关节炎、3例韦格纳肉芽肿病、1例多软骨炎和1例古德帕斯彻综合征；（2）感染性巩膜炎，包括4例带状疱疹性眼炎和2例假单胞菌性巩膜炎；（3）特发性巩膜炎，无系统性疾病证据，共19例。第一组主要表现为巩膜坏死，周围有肉芽肿性炎症和血管炎。这些病例均未显示淋巴滤泡，也未显示炎症部位有成纤维细胞和血管增殖的愈合迹象。特发性组显示少量巩膜坏死小病灶，主要为非肉芽肿性炎症。此外，在这组眼睛中有肉芽组织和淋巴滤泡增殖的证据。
