Sainz de la Maza M, Foster C S, Jabbur N S
Ocular Immunology Service and the Hilles Immunology Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114, USA.
Ophthalmology. 1997 Jan;104(1):58-63. doi: 10.1016/s0161-6420(97)30361-3.
Anterior uveitis may accompany scleritis. This study was undertaken to analyze the incidence, characteristics, and meaning of uveitis in the course of scleritis.
Patient characteristics, scleritis type, ocular complications, and specific systemic diseases were evaluated in patients with scleritis-associated uveitis; comparisons were made between patients with scleritis-associated uveitis and patients with scleritis without uveitis.
Seventy three (42%) of 172 patients with scleritis had anterior uveitis. Scleritis-associated uveitis ranged from mild to moderate intensity and always was related to the presence of active scleritis. Patients with scleritis-associated uveitis had more necrotizing scleritis (37%, P = 0.0001), decrease in vision (49%, P = 0.0046), peripheral ulcerative keratitis (22%, P = 0.0095), and glaucoma (19%, P = 0.0313) than did patients with scleritis without uveitis. Patients with scleritis-associated uveitis did not have any specific associated systemic disease more often than did patients with scleritis without uveitis.
Extension of scleral inflammation to the anterior uveal tract is a consequence of a more severe disease with possible ocular complications that may cause progressive visual loss. The occurrence of anterior uveitis in the course of scleritis entails a poor ocular prognosis. The authors believe, therefore, that the anterior uveal tract should be evaluated at every follow-up visit of a patient with scleritis, so that emergence of this important prognostic condition (anterior uveitis) may be detected promptly and systemic therapy instituted appropriately.
前葡萄膜炎可能伴随巩膜炎。本研究旨在分析巩膜炎病程中葡萄膜炎的发病率、特征及意义。
对巩膜炎相关葡萄膜炎患者的患者特征、巩膜炎类型、眼部并发症及特定全身性疾病进行评估；并对巩膜炎相关葡萄膜炎患者与无葡萄膜炎的巩膜炎患者进行比较。
172例巩膜炎患者中有73例（42%）发生前葡萄膜炎。巩膜炎相关葡萄膜炎程度从轻度到中度不等，且总是与活动性巩膜炎的存在相关。与无葡萄膜炎的巩膜炎患者相比，巩膜炎相关葡萄膜炎患者有更多的坏死性巩膜炎（37%，P = 0.0001）、视力下降（49%，P = 0.0046）、周边溃疡性角膜炎（22%，P = 0.0095）和青光眼（19%，P = 0.0313）。巩膜炎相关葡萄膜炎患者与无葡萄膜炎的巩膜炎患者相比，没有任何特定的相关全身性疾病更为常见。
巩膜炎症扩展至前葡萄膜是病情更严重的结果，可能伴有眼部并发症，可导致进行性视力丧失。巩膜炎病程中发生前葡萄膜炎预示眼部预后不良。因此，作者认为，在巩膜炎患者的每次随访中都应评估前葡萄膜，以便能及时发现这一重要的预后情况（前葡萄膜炎）并适当开展全身治疗。
