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The Clinical Features of Posterior Scleritis with Serous Retinal Detachment: a Retrospective Clinical Analysis

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The Clinical Features of Posterior Scleritis with Serous Retinal Detachment: a Retrospective Clinical Analysis The clinical features of posterior scleritis with serous retinal detachment: A retrospective clinical analysis Zhizhang Dong The second aliated hospital and Yuying Children’s hospital of Wenzhou Medical University https://orcid.org/0000-0001-5150-8750 Yifeng Gan The second aliated hospital and Yuying Children’s hospital of Wenzhou Medical University Yinan Zhang The second aliated hospital and Yuying Children’s hospital of Wenzhou Medical University Yu Zhang The second aliated hospital and Yuying Children’s hospital of Wenzhou Medical University Juan Li ( [email protected] ) Guangren Hospital Aliated to School of Medicine of Xi'an Jiaotong University Haihua Zheng ( [email protected] ) The second aliated hospital and Yuying Children’s hospital of Wenzhou Medical University Research Article Keywords: Posted Date: November 30th, 2018 DOI: https://doi.org/10.21203/rs.2.48/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published at International Journal of Ophthalmology on July 18th, 2019. See the published version at https://doi.org/10.18240/ijo.2019.07.16. Page 1/13 Abstract Objective: To summarize the clinical features, systemic associations, risk factors and choroidal thickness(CT) changing in posterior scleritis (PS) with serous retinal detachment. Methods: This retrospective study included 23 patients with PS with retinal detachment from August 2012 to July 2017. All patients were documented with the Medical history and clinical features were recorded. The examinations included best corrected visual acuity (BACV), intraocular pressureIOP, fundus examination, routine eye examinations. Posterior coats thickness (PCT) was determined by B scan Ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). And clinical data were compiled and analyzed. Results: After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5 ± 9.24 years old. Ocular pain and blurred vision were the two most common symptoms complained by patients. Anterior scleritis occurred in 12 patients, which was conrmed by Ultrasound Biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no uorescein leakage was observed in the macular. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT increased with uid in Tenon’s capsule demonstrated as a typical T-sign. The average PCT was 2.51 ± 0.85 mm in the PS-affected eye and only 1.09 ± 0.29 mm in the unaffected eye; this difference reached statistical signicance. The subfoveal CT increased to an average of 442.61 ± 55.61μm, which correlated with axis length and PCT, but not with IOP. The BCVA and IOP did not correlate with either CT or the PCT. Conclusions: PS with serous retinal detachment presented with a variety of symptoms, such as pain and visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound was a useful conrmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inammation. Introduction Posterior scleritis (PS) is an uncommon and under-diagnosed condition caused by inammation of the sclera (i.e. the brous outer layer of the eye) [1]. Due to its low incidence and variable clinical presentation, the mechanism underlying PS remains unclear and the majority of the research to date has focused instead on characterizing its clinical features, and optimizing diagnosis, treatment, and patient outcome[2-4]. Based on the anatomical location, PS presents with a range of clinical features, especially in fundus change, and, therefore, is often misdiagnosed as intraocular inammation[5], ocular tumors[6], or orbital inammation[7]; such misdiagnoses[8] increase the likelihood of incurring irreversible visual damage including eventual vision loss. Given the high rates of retinal detachment in PS[4], this condition can be easily misdiagnosed as central serous chorioretinopathy (CSC), which is characterized by retinal detachment in or around the macula. There is currently a paucity of research dedicated to detailing the differences between these two diseases. These factors motivated our interest in the clinical features and risk factors involved in PS with Page 2/13 retinal detachment specically. This research was performed toward fully characterizing the clinical features, systemic associations, and risk factors in PS with retinal detachment. Recently some studies have suggested that choroidal expansion might play an important role in PS[9, 10]. Due to advances in ophthalmic imaging equipment, choroidal thickness (CT) can be noninvasively measured by enhanced depth imaging optical coherence tomography (EDI-OCT). While studies have implicated the importance of CT in PS, but none have focused on how CT is involved in PS with retinal detachment[10, 11]. Furthermore, CT is increasingly being considered as an important risk factor in the pathophysiology of PS. However, little is known about the association between CT and other ocular biometric parameters, such as visual acuity, axial length (AL) and posterior coats thickness (PCT), in PS, let alone in PS with retinal detachment. Therefore, this study aimed to investigate the clinic ndings and association of CT in PS with serous retinal detachment by a retrospective clinical analysis. Methods Subjects and Enrollment Criteria This study was approved by the Ethical Review Committee of the Second Aliated Hospital of Wenzhou Medical University, Wenzhou City, China. All procedures adhered to the tenets of the Declaration of Helsinki for research involving human subjects. Written informed consent was obtained from all participants enrolled in this study. All potential study participants were from a Chinese Han population and patients of the aforementioned clinic. A retrospective review of patient medical records from the ophthalmological clinic at the Second Aliated Hospital of Wenzhou Medical University between 2012 and 2017 was performed to identify patients with a diagnosis of PS. For the purpose of this study, PS was diagnosed by presence of (1) acute or sub-acute symptom onset; (2) eye pain with or without decreased visual acuity, accompanied by various fundus changes (e.g. optic disc edema, retinal phlebectasia, exudative retinal detachment); (4) eyeball thickening and uid in the Tenon’s capsular with low echo and fascial sac edema in the eye coats, dened as typical "T" sign[3, 4, 12], revealed by B-scan ultrasound examination; Patients with any of the following conditions were excluded: incomplete clinical information, infection with acute orbital cellulitis, tuberculosis, or syphilis; trauma; tumor; the orbital inammatory pseudotumor; Grave's ophthalmopathy; macular retinal detachment with abnormal leakage in fundus uorescein angiography; rhegmatogenous retinal detachment; any obvious cataract leading to an intumescent lens; a history of intraocular surgery; inability to tolerate ophthalmological examination; clinically relevant opacities of the optic media; and low-quality images due to unstable xation or a severe cataract. Of the 69 records initially identied, 16 were excluded because of insucient clinical detail to ensure a correct diagnosis or lack of satisfactory ultrasonography data. 30 PS patients were not included because no sub retinal uid was detected in our research. Page 3/13 After the application of the inclusion and exclusion criteria, 23 remaining patients were included in this study. All enrolled patients were diagnosed with PS presenting serous retinal detachment over the macula. Study Measurements Demographic data on age, sex, and blood pressure were collected. Detailed clinical information regarding original diagnosis, disease onset, clinical presentation, ultrasound data, and systemic associations was recorded. All patients were regularly tested with regular blood test, CRP, ERS, P-ANCA, C-ANCA, ANA, PANA, “ASO” antigen test, dsDNA antibody, SS-A and SS-B antibody, complement series, SAA, RF factor, Immunoglobulin G and M. All subjects underwent a thorough ophthalmic evaluation, including the best corrected visual acuity (BCVA) assessment, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement (applanation tonometry), fundus examination, ultrasonographic biomicroscopy, ultrasound (UBM), B-mode scanning (B-scan, Bio-vision Echosens, France), fundus uorescein angiography (FFA), refractive error examination, and Axial Length (AL) measured with partial optical coherence interferometry (IOL Master; Carl Zeiss Meditec, German). All examinations were performed upon diagnosis by experienced ophthalmologists who are blinded to the patients diagnosis. EDI-OCT Examination As previously described[13], CT was determined using the Spectralis device (Heidelberg Engineering, Heidelberg, Germany), by using the device’s automatic averaging (about 100 real-time frames were averaged) and eye-tracking features. First of all, in order to estimate optical magnication and achieve accurate comparisons across individuals, keratometry readings and the refraction data were collected and entered into the Spectralis software program. For the aim of ensuring high-quality images, Tthe quality of choroidal imaging was judged according to the signal-to-noise ratio, and only images ratios ≥ 20 dB were collected and used for further analysis. The resulting scans
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