The clinical features of posterior scleritis with serous retinal detachment: a retrospective clinical analysis

Abstract

Aim: To summarize the clinical features, systemic associations, risk factors and choroidal thickness (CT) changing in posterior scleritis (PS) with serous retinal detachment.

Methods: This retrospective study included 23 patients diagnosed PS with retinal detachment from August 2012 to July 2017. All patients' medical history and clinical features were recorded. The examinations included best corrected visual acuity (BCVA), intraocular pressure (IOP), fundus examination, and routine eye examinations. Posterior coats thickness (PCT) was determined by B-scan ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and clinical data were compiled and analyzed.

Results: After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5±9.24 years old. Ocular pain and blurred vision were the two most common complained symptoms by patients. Anterior scleritis occurred in 12 patients, which was confirmed by ultrasound biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no fluorescein leakage was observed in the macular area. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT increased with fluid in Tenon's capsule demonstrated as a typical T-sign. The average PCT was 2.51±0.81 mm in the PS-affected eyes and only 1.09±0.29 mm in the unaffected eye (P<0.0001). The subfoveal CT was 442.61±55.61 µm, which correlated with axis length (r=-0.65, P=0.001) and PCT (r=0.783, P<0.001). The BCVA and IOP did not correlate with either CT or PCT.

Conclusion: PS with serous retinal detachment presented a variety of symptoms, such as pain, visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound is a useful confirmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inflammation.

Keywords: choroidal thickness; clinical features; posterior scleritis; scleritis; serous retinal detachment.

Figure 1. Clinical findings of posterior scleritis in case 1

A: Fundus imaging of disc swelling, retinal phlebectasia, and serous retinal detachment (white arrow) at the macula; B: Fluorescein leakage around the optic nerve at the late stage in FFA; C: EDI-OCT scanning of serous detachment over the macula. The short arrows indicate the chorioscleral interface and red segment length indicate subfoveal CT (the CT of the left eye was 607 µm at the initial visit); D: Ultrasound scan of scleral thickening and black arrows denote the posterior boundary of the sclera. E-H: Normal structure in the unaffected eye of case 1; fundus photography (E), FFA (F), EDI-OCT (G) and B-scan ultrasonography (H).

Figure 2. Clinical findings of posterior scleritis with serous retinal detachment

A: Anterior segment examination showed conjunctival congestion and anterior scleritis with tenderness in the upper part of the sclera; B: UBM examination detected swelling and hyperemia in the superficial fasciitis and sclera at the 12 o'clock; C: Posterior segment examination revealed retinal detachment at the macula (white arrow); D: FFA illuminated the serous retinal detachment at the macula but no fluorescein leakage was detected; E: The OCT scanning confirmed serous retinal detachment at the macula; F: B-scan ultrasonography confirmed scleral thickening (black arrows indicate the posterior boundary of the sclera and the retinal detachment is indicated by the white triangle); G: B-scan ultrasonography showing diffuse thickening of the posterior coats of the eye (3.6 mm) together with fluid in the Tenon's capsule (white arrow). The “T” sign is indicated by the white hollow shape. H: The increases in the PCT correlated positively with the increasing CT (r=0.783, P<0.001).