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Clinical patterns and risk factors in scleritis: a multicentric study in Colombia

  • Inflammatory Disorders
  • Published:
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Abstract

Purpose

This study aims to describe the clinical characteristics of scleritis in a large cohort of Colombian patients and identify factors associated with the clinical presentation.

Methods

Retrospective case series of patients with scleritis from 2015 to 2020. Clinical records were obtained from seven uveitis referral centers in Colombia. Patients with a diagnosis of episcleritis were excluded.

Results

We evaluated 389 patients with scleritis (509 eyes). There was a female predominance (75.6%) with a mean age of 51 ± 15 years. Most cases were noninfectious (94.8%) and unilateral (69.2%). The most frequent type of inflammation was diffuse anterior scleritis (41.7%), followed by nodular scleritis (31.9%) and necrotizing scleritis (12.3%). Systemic autoimmune diseases were found in 41.3% of patients, the most common being rheumatoid arthritis (18.5%) and granulomatosis with polyangiitis (5.9%). Polyautoimmunity was found in 10.4% of those with a systemic autoimmune disease. The most frequent treatment was systemic steroids (50.9%), followed by systemic NSAIDs (32.4%). Steroid-sparing immunosuppression was required in 49.1% of patients. Systemic autoimmune diseases were more common in patients with necrotizing scleritis and those older than 40 years of age. Best-corrected visual acuity of 20/80 or worse at presentation was more common in necrotizing scleritis and subjects with associated uveitis, ocular hypertension, or who were over 40 years of age.

Conclusions

This is the first study in Colombia and the largest in Latin America describing the clinical characteristics and presentation patterns of scleritis. The most common presentation was in females, with unilateral, anterior diffuse noninfectious scleritis. Systemic autoimmune diseases and polyautoimmunity were frequent, as was the need for steroid-sparing immunosuppression. Age over 40 and necrotizing scleritis were associated with higher odds of having a systemic autoimmune disease and worse visual acuity at presentation.

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Data availability

The information in the databases used in this article is freely accessible and is available for research purposes.

Abbreviations

ANA:

Antinuclear antibodies

ANCA:

Anti-neutrophil cytoplasmic antibodies

BCVA:

Best-corrected visual acuity

GPA:

Granulomatosis with polyangiitis

HLA-B27:

Human leukocyte antigen B27

IQRs:

Interquartile range (IQRs)

NS:

Necrotizing scleritis

NSAIDs:

Systemic non-steroidal anti-inflammatory drugs

OR:

Odds ratio

PolyA:

Polyautoimmunity

PUK:

Peripheral ulcerative keratitis

RA:

Rheumatoid arthritis

RF:

Rheumatoid factor

SD:

Standard deviation

SSI:

Steroid-sparing immunosuppression

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Funding

Convocatoria de Investigación Álvaro Rodríguez González Fundación Oftalmológica Nacional.

Author information

Authors and Affiliations

  1. Neuroscience Research Group (NEUROS), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia

    Alejandra de-la-Torre, Juliana Reyes-Guanes, Carlos Cifuentes-González & William Rojas-Carabali

  2. Uveitis Department, Fundación Oftalmológica Nacional (FUNDONAL), Bogotá, Colombia

    Mariana Cabrera-Pérez, María Alejandra Martínez-Ceballos & María Elisa Mejía

  3. School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia

    Mariana Cabrera-Pérez, María Alejandra Martínez-Ceballos & María Elisa Mejía

  4. Ocular Immunology and Uveitis Department, School of Medicine and Health Sciences, Universidad CES, Medellín, Colombia

    Claudia Durán & Camilo Andrés Gómez-Durán

  5. Department of Ophthalmology, School of Medicine and Health Sciences, Universidad Pontificia Javeriana, Cali, Colombia

    Sandra García & Yanny Pérez

  6. Department of Ophthalmology, School of Medicine and Health Sciences, Universidad de Antioquia, Medellín, Colombia

    Miguel Cuevas

  7. Department of Ophthalmology, School of Medicine and Health Sciences, Universidad Industrial de Santander, Universidad Autónoma de Bucaramanga, Foscal, Centro Oftalmológico Virgilio Galvis, Floridablanca/Santander, Colombia

    Néstor Carreño, Carlos M. Rangel & Alejandra Gómez-Rocha

  8. Ocular Immunology and Uveitis Department, Oftalmosanitas, Fundación Universitaria Sanitas, Bogotá, Colombia

    Diana Isabel Pachón-Suárez

Authors
  1. Alejandra de-la-Torre
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  2. Mariana Cabrera-Pérez
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  3. Claudia Durán
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  4. Sandra García
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  7. Carlos M. Rangel
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  16. William Rojas-Carabali
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Contributions

Mariana Cabrera-Pérez, MD, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed equally to this work. Concept and design: Mariana Cabrera-Pérez, MD; Alejandra de-la-Torre, MD, PhD; Claudia Duran, MD; Sandra García, MD; Miguel Cuevas, MD; Néstor Carreño, MD; Carlos M Rangel, MD; Diana Pachón, MD. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: Alejandra de-la-Torre, MD, PhD; Mariana Cabrera-Pérez, MD; Carlos Cifuentes-González, MS; William Rojas-Carabali, MD; María Alejandra Martínez-Ceballos, MD; María Elisa Mejía, MD. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Mariana Cabrera-Pérez, MD. Administrative, technical, or material support: N/A. Supervision: N/A.

Corresponding author

Correspondence to Mariana Cabrera-Pérez.

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Ethics approval

This study adheres to the ethical principles for human research established by the Helsinki Declaration, the Belmont Report, and Colombian Resolution 008430 of 1993. According to the risks contemplated in resolution 8430 from 1993, this investigation is considered without risks. The information in the databases used in this article is freely accessible and is available for research purposes. In the same way, their coding system ensures data confidentiality. The present study was approved by the ethics committee of the Fundación Oftalmológica Nacional.

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The authors declare no competing interests.

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de-la-Torre, A., Cabrera-Pérez, M., Durán, C. et al. Clinical patterns and risk factors in scleritis: a multicentric study in Colombia. Graefes Arch Clin Exp Ophthalmol 260, 3957–3967 (2022). https://doi.org/10.1007/s00417-022-05754-y

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