Adalimumab for refractory peripheral ulcerative keratitis

Cordero‐Coma, Miguel; Méndez, R. Salazar; Blanco, Álvaro Casado; Corral, Ana López; Calleja-Antolín, Sara; Morales, José

doi:10.1007/s12348-012-0080-z

Cited by 12 publications

(9 citation statements)

References 7 publications

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“…In some cases, topical steroids, antibiotics, and even surgical therapy with conjunctival resection of the inflamed area, as well as amniotic membrane grafting, may be successful local treatments for unilateral PUK and systemic-associated disease [ 74 ].…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

Peripheral Ulcerative Keratitis Associated with Autoimmune Disease: Pathogenesis and Treatment

Cao

Zhang

et al. 2017

Journal of Ophthalmology

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Peripheral ulcerative keratitis (PUK) is type of crescent-shaped inflammatory damage that occurs in the limbal region of the cornea. PUK is always combined with an epithelial defect and the destruction of the peripheral corneal stroma. PUK may have a connection to systemic conditions, such as long-standing rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Wegener granulomatosis (WG), relapsing polychondritis, classic polyarteritis nodosa and its variants, microscopic polyangiitis, and Churg-Strauss syndrome. However, the most common connection is with RA, which is also the focus of this review. The pathogenesis of PUK is still unclear. It is thought that circulating immune complexes and cytokines exert an important influence on the progression of this syndrome. Treatment is applied to inhibit certain aspects of PUK pathogenesis.

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Section: Rheumatoid Arthritismentioning

confidence: 99%

Peripheral Ulcerative Keratitis Associated with Autoimmune Disease: Pathogenesis and Treatment

Cao

Zhang

et al. 2017

Journal of Ophthalmology

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“…30 Ocular involvement includes mainly episcleritis and uveitis, with PUK as a rare association. 29,30,31,32,33 Peripheral ulcerative keratitis in IBD can be the presenting feature of IBD or presents after previously diagnosed disease. 29,30,31,32,33 It affects men and women equally, favouring a younger onset from 33 years to 55 years.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

“…29,30,31,32,33 Peripheral ulcerative keratitis in IBD can be the presenting feature of IBD or presents after previously diagnosed disease. 29,30,31,32,33 It affects men and women equally, favouring a younger onset from 33 years to 55 years. 29,30,31,32,33 This cohort of patients have a more severe form of PUK, with most needing escalation of immunosuppressive therapy to biological agents in order to achieve disease control.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Peripheral ulcerative keratitis: A review of aetiology and management

Hӧllhumer

2022

African Vision and Eye Health

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Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory disease of the peripheral cornea that can be caused by local factors or systemic inflammatory disease.Aim: The purpose of this review is to give an overview of the pathophysiology, aetiology, clinical features, diagnosis, and management of PUK.Method: A PubMed search was conducted using the keywords, ‘peripheral ulcerative keratitis’ and ‘Mooren’s ulcer’.Results: The peripheral cornea has unique characteristics the predispose to the development of PUK. These include fine capillary arcades that allow for deposition of immune complexes and subsequent activation of an inflammatory cascade with corneal melt. Several conditions have been implicated in the aetiology of PUK. The most commonly cited causes are rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA) and various dermatoses. In patients with RA, PUK usually presents in established disease, whereas in GPA, PUK may be the presenting feature in up to 60% of cases. In RA it heralds the onset of a systemic vasculitis with significant associated morbidity and mortality. The management of PUK follows an individualised stepwise approach. All patients require supportive measures to encourage healing and halt the process of keratolysis. Systemic autoimmune conditions need a systemic corticosteroid as a fast-acting agent to halt the inflammatory process while cytotoxic therapy maintains long term disease control. Failure to achieve disease control with CTT, necessitates the use of a biologic agent.Conclusion: Peripheral ulcerative keratitis is a severe inflammatory disease of the peripheral cornea that needs a thorough diagnostic workup and stepwise management approach.

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“…Bandage contact lenses, patching with amniotic membrane, resection of conjunctiva adjacent to PUK, topical steroids, antibiotics, and topical immunosuppressives are the topical treatment options in PUK with unilateral AID (54). Topical use of corticosteroids reduce systemic side effects and improve the lesion significantly, but epithelial healing may be delayed and new collagen production may be inhibited.…”

Section: B) Treatmentmentioning

confidence: 99%

“…Adalimumab is a humanized recombinant IgG1 monoclonal antibody that targets TNF-alpha. The subcutaneous delivery ofadalimumab is a significant advantage compared with infliximab, which is delivered by infusion (54). Golimumab is also a biological agent.…”

Section: B) Treatmentmentioning

confidence: 99%

Clinical findings, pathogenesis and treatment in non-infectious peripheral ulcerative keratitis

Açıkalın¹

2018

Beyoglu Eye J

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Peripheral ulcerative keratitis (PUK) is a group of diseases that manifest with ulceration and/or thinning in the peripheral cornea. Although this group of diseases can occur as a result of infection, most cases are of immunological origin and are associated with autoimmune diseases (AID). The most common form of AID associated with PUK is rheumatoid arthritis (RA). However, PUK may also be seen with other AIDs, such as systemic lupus erythematosus and Wegener's granulomatosis. There are immunological differences between the peripheral and central cornea that may explain the localization of PUK in the peripheral cornea. For example, the proximity to limbal blood vessels and conjunctival lymphatics is different. Both humoral and cellular immunity play a role in the development of PUK. Although the number of CD8+ T cells did not vary significantly in RA patients, the number of CD4+ T cells was significantly greater. As PUK is very serious, early diagnosis and treatment are very important. Local and systemic corticosteroids, immunosuppressants, biological agents, bandage contact lenses, tissue adhesives, and in some cases, surgical treatment can be applied. Adjacent conjunctival excision, patch lamellar grafts, and keratoplasty are options in surgical treatment. It is very important not to forget the possibility of disease progression despite surgery, and the treatment of underlying disease is crucial. Keratoplasty in PUK cases may not be successful as a result of several factors, such as dry eye and the underlying immunological disease..

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Adalimumab for refractory peripheral ulcerative keratitis

Cited by 12 publications

References 7 publications

Peripheral Ulcerative Keratitis Associated with Autoimmune Disease: Pathogenesis and Treatment

Peripheral Ulcerative Keratitis Associated with Autoimmune Disease: Pathogenesis and Treatment

Peripheral ulcerative keratitis: A review of aetiology and management

Clinical findings, pathogenesis and treatment in non-infectious peripheral ulcerative keratitis

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