Visual outcome, treatment results, and prognostic factors in patients with scleritis

Ophthalmology. 2013 Feb;120(2):379-86. doi: 10.1016/j.ophtha.2012.08.005. Epub 2012 Nov 20.


Purpose: To analyze the visual outcome, systemic associations, effectiveness of treatment, and predicting features of 104 scleritis patients.

Design: Retrospective case series.

Participants: One hundred four patients treated for scleritis at the University Medical Centers of Groningen and Utrecht, The Netherlands.

Methods: The clinical records of 104 patients diagnosed with scleritis between 1992 and 2011 at the University Medical Centers of Groningen (n = 64) and of Utrecht (n = 40) were analyzed retrospectively.

Main outcome measures: Loss of visual acuity, ocular complications, related systemic disease, type of treatment, time to treatment success, and predictive features.

Results: Mean age ± standard deviation (SD) was 51.5 ± 13.6 years, and 63 (60.6 %) patients were female. Mean follow-up ± SD was 38.2 ± 33.8 months. A loss of more than 2 lines of Snellen acuity was observed in 23 patients, 3 of whom had a final visual acuity of no light perception. In general, patients with necrotizing scleritis (n = 15) had a poorer outcome. Ocular complications were observed in 88 (84.6%) patients. Underlying systemic disease was identified in 34 (32.7%) patients. Steroid-sparing immunosuppressive medication was used in 47 patients, 36 of whom were treated with methotrexate (MTX). This treatment was successful in 17 (47.2%) patients over the course of a mean ± SD of 103.7 ± 83.7 weeks. Mycophenolate mofetil was the treatment in 10 patients, and in 5 of these patients, treatment success was achieved in a mean ± SD of 65.3 ± 37.4 weeks. Treatment with tumor necrosis factor α (TNF-α) antagonists led to treatment success in a mean ± SD of 32.6 ± 21.8 weeks in 5 of the 11 treated patients. Patients with loss of visual acuity or those treated with steroid-sparing immunosuppressive drugs more often had an underlying associated disease, bilateral scleritis, and a longer duration of symptoms at presentation.

Conclusions: Scleritis is a severe ocular inflammatory disease often associated with ocular complications. In this population, roughly half of the patients were treated with systemic immunosuppressive medication. Mycophenolate mofetil and TNF-α antagonists can be used in case of MTX failure. Tumor necrosis factor α antagonists seemed to be more effective than MTX. Within this group, an underlying associated disease, bilateral scleritis, and a longer duration of symptoms at presentation were predictive features for a more severe disease course.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Female
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Methotrexate / therapeutic use
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Scleritis / diagnosis*
  • Scleritis / drug therapy*
  • Scleritis / physiopathology
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Visual Acuity / physiology*
  • Young Adult


  • Anti-Inflammatory Agents, Non-Steroidal
  • Immunosuppressive Agents
  • Tumor Necrosis Factor-alpha
  • Mycophenolic Acid
  • Methotrexate