Alterations in choroidal circulatory dynamics and choroidal thickness before and after treatment in posterior scleritis

Abstract

Background: Posterior scleritis is an inflammatory reaction of the sclera that occurs posterior to the ora serrata. The aim of this study was to present a case of posterior scleritis and to analyze choroidal circulatory and structural changes using laser speckle flowgraphy (LSFG) and optical coherence tomography (OCT), respectively.

Case presentation: A 64-year-old man presented to our department because of hyperemia of the left eye for one week, diplopia, ocular pain, and distorted vision when looking leftward. At an initial examination, his best-corrected visual acuity was 1.0 Oculi uterque (OU), with mild conjunctival hyperemia oculus dexter (OD) and marked ciliary hyperemia oculus sinister (OS). Color fundus photographs revealed a cluster of choroidal folds extending from the macula to the inferior retinal region OS. Swept-Source OCT showed choroidal thickening OD, and bacillary layer detachment and paracentral middle maculopathy on the paracentral side of the optic nerve papilla, suggesting severe inflammation. Fluorescein angiography showed hyperfluorescence in the optic disc and window defects around the macula OU. Indocyanine green angiography showed mottled choroidal vascular hyperpermeability findings in the late stage. B-mode echography displayed thickening of the posterior wall of the left eye. Orbital magnetic resonance imaging showed the thickened posterior eyeball. The patient was diagnosed with posterior scleritis, and 30 mg of oral prednisolone was then given and tapered off over the next 4 months. The hyperemia and intraocular inflammation resolved after the treatment. The rate of change in macular blood flow assessed by the mean blur rate on LSFG was 20.5% and 20.2% decrease OD and OS, respectively, before and after treatment. The central choroidal thickness showed 8.8% and 37.8% decrease OD and OS, respectively.

Conclusion: Posterior scleritis complicated with choroiditis was suggested to show different choroidal circulatory dynamics from those in other choroidal inflammations.

Keywords: Choroidal circulatory dynamics; Choroiditis; Laser speckle flowgraphy; optical coherence tomography; Posterior scleritis.

Fig. 1

Initial findings on slit-lamp microscopy. A, B Slit-lamp microscopy detected mild conjunctival hyperemia and mild cataracts oculus dexter (OD) (A) and marked conjunctival and ciliary hyperemia oculus sinister (OS) (B)

Fig. 2

Initial findings on color fundus photography (CFP), swept-source optical coherence tomography (SS-OCT), B-mode echography, fluorescein angiography (FA), and indocyanine green angiography (ICGA) in the present case of posterior scleritis. A, B CFP revealed no abnormality OD (A), while a cluster of choroidal folds extended from the macula to the inferior retinal region OS (B, white arrowheads). C, D SS -OCT showed choroidal thickening OU, and bacillary layer detachment (D, red arrowhead) and paracentral middle maculopathy (D, yellow arrowhead) on the paracentral side of the optic nerve papilla. E SS-OCT of the choroidal bulge showed retinal creases (red arrowheads) and dilation of the vascular lumens (yellow arrowheads). F B-mode echography displayed thickening of the posterior wall of the left eye. G, H FA showed hyperfluorescence in the optic nerve papilla and window defects around the macula OU in the late stage. I, J ICGA showed mottled choroidal vascular hyperpermeability in the late stage (I and J, yellow arrowheads). Linear hyperfluorescent lesions were detected OS corresponding to the extramacular choroidal folds on CFP and SS-OCT (J, red arrowheads)

Fig. 3

Mean blur rate (MBR) by laser speckle flowgraphy (LSFG) and the central choroidal thickness (CCT) in the present case of posterior scleritis. A The MBR decreased temporarily at acute phase but gradually increased at subacute phase. The CCT decreased during the recovery phase. B The MBR decreased temporarily at acute phase but gradually increased at subacute phase. The CCT decreased immediately after the start of treatment

Fig. 4

LSFG color map in the present case of posterior scleritis. A, B, C, D LSFG color map in the left eye showed a vertical difference because of the inferior choroidal bulge caused by the nodular lesion of scleritis. E, F, G, H LSFG color map in the right eye showed no vertical difference