误诊为中浆及视网膜炎的后巩膜炎 1 例并文献复习

A case of posterior scleritis initially misdiagnosed as central serous chorioretinopathy and retinitis

摘要

目的 探讨后巩膜炎的病因、发病机制、临床表现、诊疗思维，主要探讨鉴别诊断、治疗方法及预后，以便对其进行早期确诊，避免误诊漏诊。方法 回顾性分析 1 例后巩膜炎患者的临床资料，总结分析本病例的诊疗过程及临床思维，并进行文献复习。结果 患者历时 8 年，经过多次误诊，最终于我院确诊并在正确治疗 1 周后，右眼最佳矫正视力由 0.12 提高到 0.30，视网膜在位，视盘水肿及黄斑区水肿较前明显减轻。1 月后右眼矫正视力恢复至 0.60。结论 后巩膜炎临床表现多样，易误诊为中心性浆液性脉络膜视网膜病变、视网膜炎等疾病。详细的问诊及仔细的查体，有助于提高后巩膜炎早期确诊率，避免误诊误治。

Abstract

Objective The aim is to investigate the etiology, pathogenesis, clinical manifestations, diagnostic and treatment methods of posterior scleritis, with a focus on differential diagnosis, treatment strategies, and prognosis. Methods A retrospective analysis of a patient with posterior scleritis was conducted, along with literature review, to summarize the diagnostic and therapeutic processes. Results Numerous misdiagnoses given to the patient over eight years were finally rectified. After one week of appropriate treatment, the best-corrected visual acuity (BCVA) in the right eye improved from 0.12 to 0.30, with a significant reduction in optic and macular edema. One month afterwards, the BCVA in the right eye further stabilized at 0.60. Conclusion Posterior scleritis can present with diverse clinical manifestations, potentially leading to misdiagnosis such as central serous chorioretinopathy or retinitis. A detailed medical history and thorough physical examination can significantly improve the early diagnosis accuracy, thereby preventing misdiagnosis and inappropriate treatment.

关键词

后巩膜炎 / 中心性浆液性脉络膜视网膜病变 / 视网膜炎 / 视盘水肿 / 黄斑水肿

Key words

Posterior scleritis / Central serous chorioretinopathy / Retinitis / Optic disc edema / Macular edema

参考文献

[1] Cifuentes-González C , Mejía-Salgado G , Rojas-Carabali W , et al. The global epidemiology of scleritis: a systematic review and meta-analysis [J]. Am J Ophthalmol, 2025, 273: 13-32. doi: 10.1016/j.ajo.2025.01.019

[2] Hyun L , Cho H , Young C , et al. Clinical features and long-term treatment outcome of posterior scleritis [J]. Ann Transl Med, 2022, 10(21): 1162. doi: 10.21037/atm-22-721

[3] Doumazos S , Kandarakis SA , Petrou P , et al. Posterior scleritis in a patient with psoriasis masquerading as acute angle closure glaucoma [J]. Case Rep Ophthalmol, 2022, 13(3): 717-723. doi: 10.1159/000526714

[4] Benson WE . Posterior scleritis [J]. Surv Ophthalmol, 1988, 32(5): 297-316. doi: 10.1016/0039-6257(88)90093-8

[5] Lavric A , Gonzalez-Lopez JJ , Majumder PD , et al. Posterior scleritis: analysis of epidemiology, clinical factors, and risk of recurrence in a cohort of 114 patients [J]. Ocul Immunol Inflamm, 2016, 24(1): 6-15. doi: 10.3109/09273948.2015.1005240

[6] Maleki A , Ruggieri M , Colombo A , et al. B-scan ultrasonography findings in unilateral posterior scleritis [J]. J Curr Ophthalmol, 2022, 34(1): 93-99. doi: 10.4103/joco.joco_267_21

[7] Maksimova MK , García EM , Renedo IO , et al. Atypical posterior scleritis mimicking an amelanotic choroidal melanoma. A case report [J]. Rom J Ophthalmol, 2021, 65(3): 282-285. doi: 10.22336/rjo.2021.57

[8] Hogan C , Vakros G , Jones R , et al. More than meets the eye: a rare case of posterior scleritis masquerading as orbital cellulitis [J]. Cureus, 2020, 12(5): e8177. doi: 10.7759/cureus.8177

[9] Roberts F. The sclera [M]//Eye Pathology. Berlin, Heidelberg: Springer, 2014: 155-172. doi: 10.1007/978-3-662-43382-9_4

[10] Promelle V , Goeb V , Guedry J . Rheumatoid arthritis associated episcleritis and scleritis: an update on treatment perspectives [J]. J Clin Med, 2021, 10(10): 2118. doi: 10.3390/jcm10102118

[11] Fraunfelder FW , Fraunfelder FT . Adverse ocular drug reactions recently identified by the National Registry of Drug-Induced Ocular Side Effects [J]. Ophthalmology, 2004, 111(7): 1275-1279. doi: 10.1016/j.ophtha.2003.12.052

[12] Murthy SI , Sabhapandit S , Balamurugan S , et al. Scleritis: Differentiating infectious from non-infectious entities [J]. Indian J Ophthalmol, 2020, 68(9): 1818-1828. doi: 10.4103/ijo.IJO_2032_20

[13] Suhler EB , Lauer AK , Rosenbaum JT . Prevalence of serologic evidence of cat scratch disease in patients with neuroretinitis [J]. Ophthalmology, 2000, 107(5): 871-876. doi: 10.1016/s0161-6420(00)00002-6

[14] Vermeirschs S , Testi I , Pavesio C . Choroidal involvement in non-infectious posterior scleritis [J]. JOphthalmicInflammInfect, 2021, 11(1): 41. doi: 10.1186/s12348-021-00269-9

[15] 陈海燕, 王平 . 易误诊的后巩膜炎 1 例并文献复习 [J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 126-130. doi: 10.6040/j.issn.1673-3770.0.2023.078

[16] CHEN Haiyan , WANG Ping . A case of posterior scleritis which was easily misdiagnosed and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 126-130. doi: 10.6040/j.issn.1673-3770.0.2023.078

[17] 陈前, 李丽萍 . 后巩膜炎的临床误诊分析 [J]. 临床医学, 2016, 36(2): 127-128

[18] Alsarhani WK , Abu El-Asrar AM . Multimodal imaging of nodular posterior scleritis: case report and review of the literature [J]. Middle East Afr J Ophthalmol, 2020, 27(2): 134-138. doi: 10.4103/meajo.MEAJO_115_20

[19] 乔岗, 代艳, 郭海科, 等 . 超声造影在诊断困难的视网膜脱离、脉络膜脱离及眼内肿块中的应用 [J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 91-93. doi: 10.6040/j.issn.1673-3770.0.2015.420

[20] QIAO Gang , DAI Yan , GUO Haike , et al. The use of CEUS in the diagnosis of retinal/choroidal detachment and associated intraocular masses in patients with equivocal findings at conventional ultrasound [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(2): 91-93. doi: 10.6040/j.issn.1673-3770.0.2015.420

[21] Robertson R , Ansari FA , Gafour S , et al. Posterior scleritis: a case report and literature review of the management of the condition [J]. Cureus, 2024, 16(6): e61537. doi: 10.7759/cureus.61537

[22] Dutta Majumder P , Agrawal R , McCluskey P , et al. Current approach for the diagnosis and management of noninfective scleritis [J]. Asia Pac J Ophthalmol, 2020, 10(2): 212-223. doi: 10.1097/APO.0000000000000341

[23] 傅博, 徐丽 . 14 例后巩膜炎的临床特征分析 [J]. 中国实用乡村医生杂志, 2019, 26(3): 36-39. doi: 10.3969/j.issn.1672-7185.2019.03.019