FOCAL SCLERAL NODULES: Retrospective Case Series and Novel Insight

The objective of this study was to add to the limited literature of focal scleral nodule (FSN).

This study was a single-center, retrospective, observational case series performed at Manchester Royal Eye Hospital (United Kingdom). Nineteen eyes from 19 patients over a 13-year period (January 2011 to January 2024) were included. The principal observations were taken from patient demographic data, fundal and autofluorescence imaging, and Enhanced Depth Imaging Optical Coherence Tomography imaging.

Most patients with FSN were female, with median age of 47 years and median visual acuity of 20/20 Snellen. Focal scleral nodules were yellow, yellow-white, orange, or orange halo in appearance. Median horizontal length of a FSN was 2.02 mm (range 0.34-4.79 mm), and median thickness was 417 µ m (range 272-803 µ m). The choroid above the FSN was thinned in nine and absent in 10 cases. Most FSN appeared hyperautofluorescent on autofluorescence imaging. Extramacular FSN appeared directly inferiorly to the optic disc in seven, inferotemporally in five, superonasally in two, and superotemporally in five cases. Seven patients demonstrated FSN within the macula, and two of these had subretinal fluid. Further investigation revealed that one of these patients with subretinal fluid had polypoidal choroidal vasculopathy at the same area as the FSN.

This study analyzed FSN lesions of a medium-sized group over a large timeframe. It provides more data in the literature for an uncommon ophthalmic lesion. Furthermore, the study described the first known case in the literature of FSN with polypoidal choroidal vasculopathy in the same area. This finding highlights a potential new complication of the condition.