This finding of the study also warrants ruling out any evidence of tuberculosis in patients with ANCA-associated scleritis from tuberculosis-endemic region as management of such patients usually requires aggressive immunomodulatory therapy often with biologicals. GPA remains an important and common cause of necrotizing scleritis. positive cANCA, but this difference was not statistically significant (= 0.806). cANCA-positive patients had statistically significant higher association with systemic rheumatic diseases (= 0.021). Conclusion: Necrotizing scleritis is the most common subtype of scleritis in ANCA-positive individuals and even in the absence of systemic involvement. All patients with ANCA positivity should be thoroughly screened to rule out any evidence of tuberculosis, especially in tuberculosis-endemic region before planning aggressive immunomodulatory therapy. 0.05. Data were analyzed using IBM SPSS Statistics, version 20.0 (International Business Machine Corp., Armonk, NY, USA). Paired of Mycobacterium tuberculosis. Three of them had radiological evidence of pulmonary tuberculosis, two showed positive result for interferon gamma release assay, and four of the six patients with positive Mantoux test were started on ATT by the chest physician. All but one patient (96.2%) were treated with oral corticosteroid (1 mg/kg/day in tapering doses) and topical corticosteroid steroid was applied in all eyes. Seventeen patients (65.4%) in the current series required immunosuppressive agents. Cyclophosphamide was the most commonly used immunosuppressives (9 patients, 34.6%) followed by methotrexate (4 patients, 15.4%) and mycophenolate mofetil (3 patients, 11.5%). Three patients who were initially started on oral methotrexate required additional immunosuppressive (mycophenolate mofetil) subsequently to achieve control of scleral inflammation. One patient was advised intravenous pulse cyclophosphamide therapy by the treating rheumatologist. Scleral inflammation in six patients with Mantoux positivity Ademetionine was treated with systemic corticosteroid after clearance from an in-house physician and chest physician; only Ademetionine one of them required additional immunosuppressive (oral methotrexate) subsequently. Oral methotrexate in this patient was added after completion of 4.5 months of ATT after obtaining clearance from the chest physician, and improvement of scleral inflammation was observed with the treatment. Treatment modalities for study patients are shown in Table 2. Table 2 Treatment modalities for study patients Open in a separate window Five patients (19.2%), three with necrotizing scleritis (18.8%) and two with diffuse anterior scleritis (14.3%), had multiple recurrences during follow-up. Seventeen eyes (51.5%) developed cataract and all of them required surgical intervention. Seven eyes (21.2%) had raised IOP C one required filtration surgery, and the remaining were managed with anti-glaucoma medications. Four eyes (12.1%) required path graft because of extreme thinning of sclera with impending perforation. Vision improved in 23 eyes (69.7%) and was maintained in 6 eyes (18.2%). Deterioration of vision was noted in DLL4 four eyes (12.1%) of cANCA-positive patients C three eyes developed phthisis and one eye had optic atrophy. The mean BCVA in pANCA group improved from 0.7 0.8 logMAR at presentation to 0.32 0.68 logMAR at the time of final follow-up, and this difference was statistically significant ( 0.0344). There was improvement in the mean BCVA in cANCA group from 1.1 1.0 logMAR Ademetionine to Ademetionine 0.5 1.1 logMAR, but this difference was not statistically significant (= 0.035). We further compared the subset of cANCA-positive patients with pANCA-positive patients Ademetionine with scleritis [Table 3]. There were no significant differences in mean age and laterality. We found that female gender was more frequently associated with pANCA-associated scleritis than cANCA (= 0.037). There were no differences.