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Clinical science
Factors affecting the resolution of acute non-infectious anterior scleritis
  1. Ahmad Abdel-Aty,
  2. Ninani Kombo
  1. Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Ahmad Abdel-Aty, Yale University School of Medicine, New Haven, Connecticut 06510, USA; ahmad.Abdel-Aty{at}aya.yale.edu

Abstract

Background/aims Tumor necrosis factor alpha (TNF-⍺) inhibitors are increasingly being used to treat scleritis, however, their efficacy has not been compared to older treatments. Additionally, few studies have assessed differences in the course of scleritis among different patient groups. We identify demographic factors, comorbidities and treatments associated with the resolution of acute scleritis.

Methods The records of patients with non-infectious anterior scleritis who presented between 1 January 2013 and 1 January 2018 were retrospectively reviewed.

Results A total of 141 patients (169 eyes) with anterior scleritis were identified. 92.9% had diffuse anterior scleritis, 5.0% had nodular anterior scleritis and 2.1% had necrotising scleritis. Topical corticosteroids were used in 66.7% of patients, systemic non-steroidal anti-inflammatory drugs (NSAIDs) in 48.9% and systemic corticosteroids in 37.6%. Non-corticosteroid immunomodulatory therapies were required in 37.6% of patients. In a Cox proportionate hazards model, factors positively associated with the resolution of an episode of scleritis included NSAID use (HR=2.145; 95% CI 1.200 to 3.832), Hispanic race (HR=2.991; 95% CI 1.115 to 7.341) and lupus erythematous (HR=6.175; 95% CI 1.774 to 21.489). Bilateral scleritis was negatively associated with resolution (HR=0.437; 95% CI 0.196 to 0.972). TNF-⍺ inhibitors (HR=3.346; 95% CI 1.277–8.763), NSAID use (HR=2.558; 95% CI 1.383 to 4.729), lupus erythematosus (HR=5.251; 95% CI 1.478 to 18.659) and Hispanic race (HR=3.198; 95% CI 1.022 to 10.005) were significantly positively associated with steroid sparing resolution.

Conclusion Patient characteristics including a lupus diagnosis and Hispanic race were associated with faster times to symptom resolution and steroid sparing resolution, as were treatments including systemic NSAIDs and TNF-⍺ inhibitors. Due to limitations in the available data, this analysis did not account for disease severity. Future prospective studies will further elucidate the relationship between these factors and patient outcomes.

  • sclera and episclera
  • treatment medical
  • vision
  • drugs
  • inflammation

Data availability statement

De-identified patient data is available upon reasonable request. Please contact the corresponding author at ahmad.abdel-aty@aya.yale.edu.

https://doi.org/10.1136/bjophthalmol-2021-318808

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    Data availability statement

    De-identified patient data is available upon reasonable request. Please contact the corresponding author at ahmad.abdel-aty@aya.yale.edu.

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    Footnotes

    • Contributors AA-A participated in the planning of the project, collected and analysed the data, and wrote the manuscript. NK participated in the planning of the project and contributed to the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.