Paracentral Rheumatoid Corneal Ulceration

Kervick, G. N.; Pflugfelder, Stephen C.; Haimovici, Robert; Brown, Harvey E.; Tozman, Elaine C.; Yee, Richard W.

doi:10.1016/s0161-6420(92)32006-8

Cited by 71 publications

(23 citation statements)

References 26 publications

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“…However, there are a number of previous observations demonstrating a positive effect of topical cyclosporine A in the treatment of immune-mediated corneal ulcers. This includes paracentral rheumatoid corneal ulceration and peripheral corneal ulceration in RA patients [10, 22]. In both studies, an arrest of keratolysis and rapid re-epithelialization could be observed following instillation of topical cyclosporine A treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Ocular involvement is mainly restricted to tear deficiency; however, potentially blinding diseases may be the consequence of scleritis and corneal involvement. Corneal changes can range from mild punctate keratitis to perforation due to severe sterile stromal ulcerations [2, 3, 10, 14, 15]. Progression of corneal melting, leading to perforation and visual loss can be relatively asymptomatic (fig.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Penetrating Keratoplasty in Rheumatoid Arthritis

et al. 2002

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of Penetrating Keratoplasty in Rheumatoid Arthritis

et al. 2002

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“…The abnormal expression of HLA class II antigens on corneal epithelial cells and keratocytes in the area of the ulcer and vasculitis of the adjacent conjunctiva is responsible for the pathology of PUK [59–61]. With the help of immune cell clustering, pannus formation leads to an augmentation in the number of blood vessels in the peripheral cornea via angiogenesis [62].…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

“…MMPs are a type of proteolytic enzyme that degrade specific extracellular matrix components [66]. Depending on the study, local fibroblasts, invading mononuclear cells, and granulocytes are the main cellular source of MMPs associated with RA [6, 59, 65]. …”

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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“…Kervick et al presented 6 patients with RA (8 eyes) with small paracentral perforating corneal ulcers in otherwise quiet eyes [12]. The initial management of 5 patients (7 eyes) consisted of systemic immunosuppression and therapeutic tissue adhesive with a bandage contact lens or tectonic keratoplasty.…”

Section: Discussionmentioning

confidence: 99%

Peripheral corneal ulceration associated with rheumatoid arthritis

et al. 2013

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Patient: Female, 60Final Diagnosis: Corneal ulcerationSymptoms: Blurred visionMedication: AbataceptClinical Procedure: —Specialty: OphthalmologyObjective:Management of emergency careBackground:To report a case of a patient with rheumatoid arthritis (RA) and associated peripheral corneal ulceration.Case Report:A 60-year-old woman with RA diagnosed 15 years ago, under immunosuppressive therapy (IV abatacept 250 mg/month), demonstrated blurring of vision in her RE (right eye). Visual acuity was 6/10 in the RE and 10/10 in the LE. Slit lamp examination revealed a paracentral superior corneal melt in the RE. Anterior chamber reaction was 2+. Laboratory investigations revealed positive anti-Ro and anti-La, anti-Extractable Nuclear Antigens (anti-ENA, ELISA), while anti-Sm, anti-Rnp, anti-Jo1 and anti-Scl70 were found negative. IgG and IgA serum immunoglobulins were found elevated, but IgE and IgM were within normal levels. Further evaluation for the underlying disease revealed highly elevated rheumatoid factor and C-reactive protein. The patient, who had been receiving anti-TNF during the last 6 months, underwent treatment with topical tobramycin and lubricants and oral prednisone 60 mg/day with tapering doses, to which methotrexate p.os. 15 mg/week was added.The condition improved within a few days after the initiation of prednisone treatment. Re-epithelization occurred 1 week after the onset of the immunosuppressive treatment. Only punctate fluorescein dye uptake was detected in the margins of the lesion.Conclusions:The effective control of the underlying disease and early diagnosis of the dry eye syndrome in RA patients may prevent serious corneal complications such as corneal ulceration. The initiation of treatment with steroids and immunosuppresants was found to halt the progression of keratolysis, and assisted re-epithelization.

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Paracentral Rheumatoid Corneal Ulceration

Cited by 71 publications

References 26 publications

Outcome of Penetrating Keratoplasty in Rheumatoid Arthritis

Outcome of Penetrating Keratoplasty in Rheumatoid Arthritis

Peripheral Ulcerative Keratitis Associated with Autoimmune Disease: Pathogenesis and Treatment

Peripheral corneal ulceration associated with rheumatoid arthritis

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