Posterior scleritis in children: clinical features and treatment.

Abstract

To summarize the clinical findings and treatment response in posterior scleritis affecting children and to compare these features with posterior scleritis affecting adults. Retrospective interventional case series. Twenty eyes of 13 patients aged younger than 18 years who were diagnosed with posterior scleritis in a tertiary referral center. Investigations and treatment were according to standard care, following published recommendations for scleritis. Clinical features, investigation results, treatment received, and visual outcome were studied. Twenty eyes of 13 patients (aged 5-16 years, median 11.53 years; 8 female, 5 male) were included. Scleritis was unilateral in 6 cases and bilateral in 7 cases at presentation. The median presenting vision was 20/30. All eyes had T-sign demonstrable on B-scan ultrasound. Concurrent anterior segment signs included anterior uveitis (80.0%) and anterior scleritis (20.0%). Posterior segment signs included optic disc swelling (95.0%) and retinal striae (85.0%). No underlying connective tissue disorder was diagnosed in any patient. Scleritis resolved with oral nonsteroidal anti-inflammatory agent alone in 1 patient (8%). Twelve patients (92.3%) received oral corticosteroid. Immunosuppressive agents were required in 11 patients (84.6%) because of relapse or intolerance to corticosteroid. The median final vision at 1 year was 20/20. Seven patients (63.6%) remained on immunosuppression at latest follow-up (median 4 years). Common features of posterior scleritis include concurrent anterior uveitis, disc swelling, and retinal striae. B-scan ultrasound demonstrating T-sign was the most useful confirmatory investigation in all cases. Systemic association is uncommon. Aggressive therapy with systemic corticosteroid achieves resolution mostly within the first year. Long-term immunosuppression is often required to prevent recurrence. Visual outcome is favorable. The author(s) have no proprietary or commercial interest in any materials discussed in this article.