Five-year outcome in immune-mediated scleritis

Immune-mediated scleritis is a rare condition, and the information on the clinical course and complications is scarce. The aim of this study was to identify prognostic factors, complications, and therapeutic effects in patients with immune-mediated scleritis.

Patients with diagnosis of scleritis and a follow-up time of 5 years were identified. Systemic disease, laboratory investigations, type of scleritis, disease activity, therapy, and complications were recorded. The study design was a retrospective, non-comparative, interventional case series.

Systemic disease was identified in 15 (37 %) patients at presentation and in 18 (45 %) after 5 years. Rheumatoid arthritis (15 %), granulomatosis with polyangiitis (7.5 %), and polychondritis (7.5 %) were the most predominant disorders. Persistent scleritis (>5 years) was associated with systemic disease (66 vs. 6 %; p < 0.05) and positive auto-antibodies (48 vs. 23 %; p = 0.18). Control of ocular inflammation was achieved in 38 of 40 (95 %). Prednisone (14 patients) and/or methotrexate (8) were the predominant drugs to control persistent disease. Complications included interstitial keratitis (2), inflammatory astigmatism (2), corneal melt (3), macular edema (6), and severe systemic disease (5).

The presence of systemic disease and positive auto-antibodies are associated with persistent scleritis. Immunosuppressive agents allow control of scleritis, but may contribute to severe systemic complications.