Stabilization of Bilateral Progressive Rheumatoid Corneal Melt with Infliximab

Antao, Sheelah; Ayoub, Tariq; Tahir, Hasan; Parmar, Dipak N.

doi:10.1155/2012/173793

Cited by 11 publications

(16 citation statements)

References 8 publications

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“…Thomas JW et al demonstrated that Infliximab was effective in three patients with PUK related to RA that was refractory to conventional treatments as it stopped the corneal thinning, reduced the conjunctival inflammation and closed the corneal epithelial defect [26]. Antao SF et al described the efficacy of Infliximab used at the dose of 5 mg/kg due to the advanced severity of the case by the stabilization of bilateral active corneal melts resistant to all conventional therapies, leading the disease progression to stop after multiple bilateral tectonic keratoplasties [27]. In a few published cases, Infliximab has proved to be the optimal option in refractory cases of RA associated scleritis and PUK [4,28,29].…”

Section: Discussionmentioning

confidence: 99%

Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy

et al. 2020

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Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory ocular disease that can affect patients with a long history of rheumatoid arthritis (RA). The use of biotherapy has revolutionized the treatment of the RA and has provided encouraging outcomes especially in the treatment of PUK reported in few cases. In this article, we describe the case of two patients with the history of perforated corneal ulcer complicating RA treated successfully by biologic agents. Case presentation: Case 1: A 45-year-old woman was diagnosed for over 17 years with sero-positive RA refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). She had received one cycle of Rituximab with clinical and biological failure. In July 2017, she presented an active RA flare with a painful left eye and a decreased visual acuity. Ocular examination revealed a corneal perforation in the left eye and a preperforation in the right eye. She received an emergency bolus of methylprednisolone 1 g/day during three consecutive days and was followed by Infliximab. After thirteen months, Infliximab was effective on the rheumatic disease and on the corneal involvement as it stopped its gradual perforation in the right eye, and stabilized corneal ulcer in the left eye. Case 2: A 68-year-old man had been diagnosed since 2010 with sero-positive RA refractory to csDMARDs complicated in July 2017 by corneal perforation in the right eye. He was hospitalized for his ocular involvement and his active RA. He received an emergency bolus of methylprednisolone 500 mg/day during three consecutive days and was followed by Rituximab. After six months, we observed the stabilization of the right eye corneal damage and the resolution of articular symptoms. Conclusions: Our cases suggest the efficacy of Infliximab (case 1) and Rituximab (case 2) as a treatment of this severe and destructive keratolysis of the cornea complicating an active RA allowing to plan corneal graft. This positive therapeutic response will contribute to increase literature reports of this therapy success.

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Section: Discussionmentioning

confidence: 99%

Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy

et al. 2020

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“…Most cases reported in the literature describe PUK as the cause of corneal perforations. [ 1 2 3 4 5 6 ] PUK causes local vasculitis and thinning of the cornea that can lead to perforation, which can be debilitating and recurrent. [ 2 ] However, the pathophysiology is not very well understood.…”

Section: Discussionmentioning

confidence: 99%

Recurrent and refractory corneal perforation secondary to rheumatoid arthritis treated with infliximab

Saleh

Qahtani

2020

Saudi Journal of Ophthalmology

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Rheumatoid arthritis (RA) can affects many organs including the eyes. Corneal perforation in the form of peripheral ulcerative keratopathy can be debilitating and difficult to manage. A 48-year-old female with known RA presented with sudden loss of vision in her left eye, she was diagnosed with left corneal perforation secondary to severe dry eye. Penetrating keratoplasty (PKP) and punctum occlusion were done. Amniotic membrane transplant (AMT) was done 1 month later due to nonhealing epithelial defect. Her RA was clinically inactive, and no changes in her current medications were made. However, 4 months later, she presented with a second corneal perforation with melting. She had another PKP and AMT with permanent temporal tarsorrhaphy. Cyclosporine 100 mg P. O. twice daily was added, but after 5 months, she presented again with a third left corneal perforation with melting. Again, PKP and AMT with tarsorrhaphy were done, and she was started on infliximab. Since then, she had a stable graft with no further corneal perforations. In summary, patients with RA can have corneal perforations even if other signs of RA are absent. If the systemic treatment that is used to treat RA fails, one should consider using other classes of drugs, such as monoclonal antibodies (e.g., rituximab), tumor necrosis factor alpha blockers (such as infliximab or adalimumab), interleukin (IL)-1 receptor antagonists (e.g., anakinra), or IL-6 receptor antagonist (e.g., tocilizumab).

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“…In this case, phacoemulsification surgery with intraocular lens implantation in the posterior chamber was performed 9 months after keratoplasty and the initiation of infliximab treatment. There was no problem during or after surgery (76). Adalimumab is a humanized recombinant IgG1 monoclonal antibody that targets TNF-alpha.…”

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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Stabilization of Bilateral Progressive Rheumatoid Corneal Melt with Infliximab

Cited by 11 publications

References 8 publications

Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy

Two cases of perforated corneal ulcers complicating rheumatoid arthritis treated successfully by biological therapy

Recurrent and refractory corneal perforation secondary to rheumatoid arthritis treated with infliximab

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

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