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Maite Sainz de la Maza, MD, PhD; C. Stephen Foster, MD; Nada S. Jabbur, MD; Stefanos Baltatzis, MD

Arch Ophthalmol. 2002;120:15-19.

Objectives  To evaluate ocular characteristics and systemic disease associations in patients with scleritis-associated peripheral keratopathy and its different patterns, and to assess any ocular or systemic prognostic significance of the presence of the types of peripheral keratopathy in patients with scleritis.

Design  Review of 125 patients with scleritis alone and 47 patients with scleritis-associated peripheral keratopathy; review of patients with scleritis and the different patterns of peripheral keratopathy: peripheral corneal thinning, stromal keratitis, and peripheral ulcerative keratitis (PUK); review of ocular and systemic outcomes comparisons between patients with scleritis with and without peripheral keratopathy.

Results  Patients with peripheral keratopathy had more necrotizing scleritis (57%, P<.001), decrease in vision (81%, P<.001), anterior uveitis (62%, P<.002), impending corneal perforation (62%, P<.001), and potentially lethal specific-disease association (87%, P<.001) than did patients with scleritis alone. Patients with PUK had the worst ocular and systemic outcomes. Of the 24 patients with PUK, 16 (67%) had necrotizing scleritis (P = .02), virtually all had a potentially lethal systemic disease (P = .02), and all had impending corneal perforation (P<.001).

Conclusion  The detection of peripheral keratopathy, and especially PUK, in a patient with scleritis indicates a poor ocular and systemic prognosis.

From the Ocular Immunology and Uveitis Service and the Hilles Immunology Laboratory, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston (Drs Sainz de la Maza, Foster, and Jabbur); and the Department of Ophthalmology, University of Athens, Greece (Dr Baltatzis). Dr Sainz de la Maza is now with the Hospital Clinico y Provincial, Barcelona, Spain.

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