Outcome of Penetrating Keratoplasty in Rheumatoid Arthritis

Abstract

Background: Keratolysis in rheumatoid arthritis is a well-known disorder that may rapidly destroy the entire corneal stroma, resulting in descemetocele formation and eventually corneal perforation. The purpose of this study was to determine the anatomical and functional results of therapeutic penetrating keratoplasty (PK) in these patients. Patients and Methods: We reviewed the charts of patients having undergone PK over a 5-year period and evaluated the outcome. In 16 eyes of 15 patients, PKs were performed (graft diameter 3.0–11.0 mm) because of corneal melting with perforation or descemetocele formation. In 9 eyes, we used topical cyclosporine A (2%) as an adjunct therapy after transplantation in addition to systemic immunosuppressive agents. Results: Following a mean follow-up time of 17 months, anatomical success could be achieved in all eyes; none of the eyes underwent enucleation or evisceration. Postoperative complications following the first PK were epithelial keratopathy in 8 eyes (50%), corneal ulceration in 5 eyes (31%), fistulation in 4 eyes (25%), suture loosing in 4 eyes (25%) and graft rejection in 2 eyes (13%). Additionally 5 regrafts were required because of recurrence of corneal melting or persistent deep stromal defects. Comparison of complications of the patients receiving topical cyclosporine A to the control group showed a statistically significant lower incidence of epithelial keratopathy (p < 0.025) and ulcer recurrence in the cyclosporine A group during the first 3 months postoperatively (p < 0.05). The final best corrected visual acuity was 20/40 in 4 eyes but was limited to 20/200 or less in 7 eyes. Conclusion: Whereas PK can be successful to restore the anatomical integrity of severely altered eyes, the high prevalence of complications limits the indication for PK as a last stage procedure when other methods of management have failed. The use of topical cyclosporine A as adjunct therapy needs further evaluation.

Kératoplastie transfixiante à visée thérapeutique : indications et résultats en Tunisie

“…Pour Killingsworth et al [3], le foyer infectieux est retiré dans la plupart des cas et l'utilisation de corticoïdes locaux semble justifiée sur de tels yeux enflammés. Par ailleurs, l'utilisation de collyre à la ciclosporine 2 % a montré son efficacité dans les greffes réalisées « à chaud » sur terrain de polyarthrite rhumatoïde [20].…”

Corneal grafting and aggressive medication for corneal defects in graft-versus-host disease following bone marrow transplantation

“…24 The transparent or almost entirely transparent corneas in 82% of the eyes was better score than the reported outcomes of urgent keratoplasty or keratoplasty performed in dry eye. 25,26 Deterioration is expected to occur over time, however, because in severe dry eye, despite maximal management with tears, the prognosis for graft survival is not good. The poor prognosis also results from a lack of nutritional and growth factors contained in normal tears that are essential for proper limbal stem cell function.…”

Immunomodulatory Therapy in Ophthalmology – Is There a Place for Topical Application?

“…In an (uncontrolled) study on patients with rheumatoid arthritis, topical CsA ointment showed a favourable effect on preventing corneal remelting [25]. However, the value of topical CsA for the prevention of graft rejection clinically remains unclear, because the results of different studies are contradictory [26, 27].…”