ABSTRACT
INTRODUCTION: Early diagnosis and initiation of immunosuppression can prevent the necessity of surgical intervention in necrotizing scleritis with inflammation and lowers the risk of perforation and loss of vision. However, clinical signs for early diagnosis and methods for monitoring response to immunosuppressive therapy are missing. METHODS: Here, we present a case of necrotizing scleritis with inflammation where avascular plaques precede scleral defects. We use slit lamp imaging and anterior segment optical coherence tomography to evaluate evolution lesions depth and impact on scleral structure. RESULTS: The patient presented 5 months after detection of avascular plaques with a new scleral ulcer of the left eye. After 3-day-administration of i.v. corticosteroids anterior segment optical coherence tomography showed progressive scleral thickening. The patient was therefore spared surgical intervention and discharged resulting in complete remission under decreasing doses of oral corticosteroids. CONCLUSIONS: Avascular plaques can precede necrotizing scleritis with inflammation by several months and may therefore qualify as early clinical signs. Anterior segment optical coherence tomography enables objective evaluation of scleral structure for making rational decisions about surgical intervention.
ABSTRACT
A 13-year-old child diagnosed with neurofibromatosis type 1 who on a routine control presented with rhegmatogenous retinal detachment associated to dialysis of the ora serrata in the left eye (OS). There were no clinical signs or history of contuse ocular trauma. Neurofibromatosis produces alterations in fibroblasts of the cortex of the vitreous base. This results in deficient production of the collagen fibers that anchor the vitreous base to the pars plana and the peripheral neurosensory retina. Thus, suboptimal function of the fibroblasts explains spontaneous avulsion of the vitreous base. Such avulsion in turn is related to dialysis of the ora serrata.
