Atypical posterior scleritis mimicking choroidal melanoma

Clinical Features, Treatment, and Visual Outcomes of Posterior Scleritis from Tertiary Eye Care Center

PURPOSE

To describe the epidemiological and clinical features and course of patients with posterior scleritis (PS).

METHODS

This retrospective, cross-sectional consecutive case series analyzed the medical records of 16 patients diagnosed with PS.

RESULTS

Female gender and unilateral involvement were dominant. Blurred vision (84.21%) and ocular pain (78.95%) were the most common presenting complaints. Serous retinal detachment was the most common ocular finding (84.21%), followed by optic disc swelling (42.11%). Increased scleral thickness was observed in all patients, although a T-sign was detected 8 of 19 eyes (42.1%). Recurrence occured in 5 of 19 eyes in mean 30.2 ± 34.7 months. Central macular thickness, choroidal thickness, and retinal nerve fiber layer thickness were reduced with treatment at final examination significantly (p = .005, .002, and .002, respectively).

CONCLUSIONS

PS should be considered in patients presenting with unilateral ocular pain and decreased vision. Not only USG findings but also OCT findings are very useful in the follow-up of treatment response.

Monocular posterior scleritis presenting as acute conjunctivitis: A case report

BACKGROUND

Posterior scleritis is a rare inflammatory ocular disease, characterized by severe and painful inflammation of the sclera. It is often misdiagnosed or underdiagnosed, due to its general and varying clinical presentation profile, which primarily involves pain and visual impairment but which can include eyelid edema, choroidal folds, serous retinal detachment, disc edema, hard exudates in fovea and subretinal mass. We report here a case of posterior scleritis, with symptoms of eye pain and red eye, initially misdiagnosed as acute conjunctivitis.

CASE SUMMARY

A 56-year-old man presented to a local hospital with complaint of pain and redness in the right eye. The initial diagnosis was acute conjunctivitis and he was given antibiotic eyedrops. Upon week-long continuance of the symptoms despite treatment, he presented to our hospital. Initial examination revealed a shallow anterior chamber in the right eye and vision reduction to 0.6. Further testing by optical coherence tomography, ultrasound biomicroscopy, and fundus photography indicated diagnosis of posterior scleritis. The patient was given methylprednisolone (oral) on a tapered reduction schedule (starting with 70 mg/d). According to the peaks and troughs of symptoms, compound betamethasone injection was administered into the bulb, culminating in discontinuation of the oral corticosteroid. Subsequent optical coherence tomography showed the subretinal fluid near the optic disc to be completely absorbed after treatment.

CONCLUSION

Posterior scleritis should be among the differential diagnosis of eye pain and redness, and diagnosis requires further ophthalmic accessory examination, such as by optical coherence tomography.

Spontaneous Resolution of a Choroidal Mass: A Case Series

Choroidal masses can be of varying etiologies including tumors of benign, primary, and metastatic nature. Herein, we report on 3 cases of well-documented solitary choroidal masses associated with exudative retinal detachments of unclear etiology (despite extensive workup) that resolved spontaneously.

Multimodal Imaging of Nodular Posterior Scleritis: Case Report and Review of the Literature

Nodular posterior scleritis represents a small percentage of all cases of posterior scleritis. Because of the scarcity of nodular posterior scleritis, it may be confused or even misdiagnosed as an intraocular tumor or posterior uveitis. Here, we are reporting a case of nodular posterior scleritis in a 25-year-old medically free male. Furthermore, we reviewed previously reported cases of nodular posterior scleritis. Our patient presented with a choroidal mass of about one disc diameter in size. In addition, the patient had exudative retinal detachment and chorioretinal folds. B scan ultrasonography showed subretinal fluid, macular nodular thickening and underlying echolucent area along with medium internal reflectivity on A scan. Fluorescein angiography revealed early pinpoint areas of hyperfluorescence and late pooling under the detached retina. Indocyanine green angiography demonstrated early diffuse hypofluorescence corresponding to the area of detachment and late multiple pinpoint spots of hyperfluorescence. After intravenous methylprednisolone 1 g for 3 days followed by a course of oral prednisolone along with mycophenolate mofetil, the patient experienced rapid recovery with improvement in vision and complete resolution of subretinal fluid. On further follow-up, the patient regained 20/20 vision. Nodular posterior scleritis is a rare unilateral disease with strong female predominance. Multimodal imaging should be employed to confirm the diagnosis. The disease must be diagnosed correctly to avoid any unnecessary diagnostic work-up and aggressive management. Most cases carry excellent prognosis with no recurrence.

Case report-immune recovery posterior scleritis in a HIV positive patient

Background

Posterior scleritis is an uncommon vision-threatening disorder that is often recurrent and difficult to cure due to its complex etiology. In HIV patients, posterior scleritis may develop several months after significant rise in CD4+ T-lymphocyte, even after several years, which may be diagnosed as late-onset immune recovery scleritis.

Case presentation

Here we report a case of posterior scleritis in a HIV positive patient who presented with severe periocular pain and decreased vision in the left eye, with exudative retinal detachment and optic nerve involvement.

Conclusions

Early differential diagnosis of immune recovery posterior scleritis and intensive corticosteroids treatment, can prevent vision loss effectively in HIV patients.