Wide-field fluorescein angiography findings in active anterior scleritis

Abstract

Objective: Describe the proportion of patients with wide-field fluorescein angiographic (WFFA) findings in patients with active anterior scleritis.

Methods: An observational, descriptive, cross-sectional study of the WFFA findings of patients with active anterior scleritis including nodular, diffuse, or necrotizing involvement was performed. Studies were performed with the Heidelberg Spectralis module (102º). Images were saved and assessed by two masked co-authors.

Results: Seventy-nine eyes from 39 patients, 31 (79%) females with a mean age of 50.5 years ± 13.98. Mean best-corrected visual acuity (BCVA) of 0.1343 ± 0.2475 logMar or 20/27. WFFA findings were observed in 39.58% of eyes with active scleritis and in 16.66% of eyes without scleritis. Systemic association was present at 50%, with ANCA-associated vasculitis being the most prevalent. WFFA findings were more frequent in cases of anterior diffuse scleritis and correlated with scleritis severity when central and peripheral leakage (p < 0.022) and cystoid macular edema (p < 0.013) were present.

Conclusions: Almost 40% of eyes with anterior scleritis have WFFA findings of vascular leakage and 16% of eyes without scleritis. Retinal vascular leakage needs to be explored as a sign of local and/or systemic activity in patients with anterior scleritis and may have implications for disease severity and management.

Keywords: ANCA-associated vasculitis; Anterior scleritis; Fluorescein angiography; Wide-field angiography.

Fig. 1

A female in her early 40s with necrotizing anterior scleritis in the right eye, associated with AAV, p-ANCA+, MPO+, with central and peripheral leakage, and cystoid macular edema (arrows) and optic nerve leakage (circle)

Fig. 2

A female in her late 40s with a diagnosis of RA and anterior nodular scleritis. WFFA in the late arteriovenous phase with the presence of peripheral vascular leakage and parietal staining in upper temporal, lower temporal, and lower nasal quadrants (arrow)

Fig. 3

Contralateral eye without scleritis of the patient in Fig. 2. WFFA in the late arteriovenous phase with the presence of peripheral vascular leakage and parietal staining in lower and upper nasal quadrants (arrow)