An analysis of therapeutic decision for scleritis.

Abstract

PURPOSE:

To compare the long-term efficacy of different systemic therapeutic regimens for patients with noninfectious anterior scleritis to establish guidelines for institution of therapy.

METHODS:

Therapeutic failure of systemic nonsteroidal anti-inflammatory drugs (NSAIDs), systemic steroidal anti-inflammatory drugs, and systemic nonsteroidal immunosuppressive drugs was evaluated in 132 patients with noninfectious anterior scleritis (diffuse, nodular, or necrotizing types).

RESULTS:

In patients with diffuse scleritis, therapeutic failure for initial regimens occurred in 7% of patients treated with NSAIDs, in 16% of patients treated with steroids, and in 27% of patients treated with immunosuppressive drugs. In patients with nodular scleritis, therapeutic failure for initial regimens occurred in 9% of patients treated with NSAIDs, in 28% of patients treated with steroids, and in 25% of patients treated with immunosuppressive drugs. Addition or substitution of steroids or immunosuppressive drugs as second- or third-line therapies helped control the scleritis. In patients with necrotizing scleritis, therapeutic failure for initial regimens occurred in 100% of patients treated with NSAIDs, in 91% of patients treated with steroids, and in 26% of patients treated with immunosuppressive drugs.

CONCLUSIONS:

In patients with diffuse and nodular scleritis, NSAIDs should be the initial choice; in case of therapeutic failure, steroids should be added or substituted as second-line therapy, tapering and discontinuing them as soon as possible while maintaining remission with continued NSAIDs; in case of therapeutic failure, immunosuppressive drugs should be added or substituted as third-line therapy. In patients with necrotizing scleritis, immunosuppressive drugs should be the initial choice.

• Authors: M Sainz de la Maza, N S Jabbur, C S Foster
• Journal: Ophthalmology (Ophthalmology) Vol. 100 Issue 9 Pg. 1372-6 (Sep 1993) ISSN: 0161-6420 [Print] United States
• PMID: 8371926 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Anti-Inflammatory Agents
• Anti-Inflammatory Agents, Non-Steroidal
• Immunosuppressive Agents
• Steroids

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anterior Eye Segment (drug effects)
• Anti-Inflammatory Agents (therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Child
• Decision Making
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Longitudinal Studies
• Male
• Middle Aged
• Scleritis (drug therapy)
• Steroids
• Treatment Outcome