Refractive changes in patients with autoimmune scleritis

Abstract

IntroductionScleritis is a severe inflammatory disease characterized byedema and inflammatory cell infiltration of the sclera [1, 2].Without treatment, the condition may be progressivelydestructive, leading sometimes to loss of vision or loss ofthe eye [1, 2].About 30–50% of all scleritis patients have an associatedsystemic disease [1]. Most common associations are:rheumatoid arthritis (50–60%) and primary systemic vas-culitis like Wegener’s granulomatosis (20%) followed byinflammatory bowel disease (15%) [1].Complications have been reported in almost 60% ofscleritis patients [1, 2]. In their series, Jabs et al. founddecreased visual acuity in 15.9% of patients during theinactive phase of the disease [1]. Sainz de la Maza et al.described this complication in 37% of their patients [2].Some authors have reported transient myopia during theacute phase of anterior diffuse [3] and necrotizing scleritis[4]. In one report transient myopia developed after cataractsurgery in a patient with necrotizing scleritis [5]. Secondaryastigmatism in patients with necrotizing scleritis has alsobeen found. The authors associated this finding to scleralthinning [6].To the best of our knowledge, no attempt to systemat-ically characterize the refractive changes associated toscleritis has been done. Our purpose was to determine theclinical characteristic, scleral rigidity, and refractivechanges in a cohort of scleritis patients who were followedup since admittance until resolution of inflammation.Material and methodsThis protocol was reviewed and approval by the hospitalethics committee and has been performed in accordancewith the ethical standards laid down in the 1964 Declara-tion of Helsinki. All the patients gave their informedconsent prior to their inclusion in the study.We included patients of the Inflammatory Eye DiseasesClinic of the “Dr. Luis Sanchez Bulnes” Hospital, with adiagnosis of noninfectious active anterior scleritis with orwithout associated systemic disease. Immunosuppressivetreatment was prescribed according to the associateddisease. All patients signed an informed consent form tobe included in the study. Demographic data of patients wereobtained. Type and location of scleral inflammation andassociated systemic disease were also recorded. Bestcorrected visual acuity (BCVA), spherical and cylindricalerror, intraocular pressure (IOP), and scleral rigidity weremeasured. Initially, an auto-refraction was made (TopconRM-A2300) followed by a mono-ocular subjective refrac-tion with Snellen chart, spherical power was determining bythe red–green test, and the cylinder by the cross cylindertechnique. Because all the patients were adult, cycloplegicrefraction was not realized. The scleral rigidity coefficientwas determinate according to Friedenwald’s nomogramusing a Schiotz tonometer [7]. Briefly, after 15 min onsupine decubitus and previous application of topical