A Case of Corneal Melt and Perforation Associated with Rheumatoid Arthritis Managed by Corneal Patch Graft

Abstract

Corneal melt is a rare yet severe complication of Peripheral Ulcerative Keratitis (PUK), observed in patients with Rheumatoid Arthritis (RA). The mortality rate associated with corneal melt is high, warranting aggressive treatment. A 50-year-old female, a known case of RA for 20 years, presented with complaints of blurred vision, watering, irritation, and photophobia in both eyes for the last year, with worsening symptoms in the Right Eye (RE) for the past 15 days. She was diagnosed elsewhere in a private hospital with RE corneal melt and perforation and inferior corneal thinning in the Left Eye (LE), with an ulcer defect. She underwent corneal perforation suturing in the RE before reaching the present facility. On examination, a sutured corneal perforation was present in the RE, and corneal thinning and melt were seen para-centrally and inferiorly in the LE. Surgical treatment with RE corneal patch graft repair was performed. The patient was given oral methotrexate and prednisolone for aggressive systemic control of RA and to ensure the survival of the patch graft. The vision in the RE improved following the procedure, maintaining the tectonic integrity of the cornea. On follow-up, aleucomatous opacity was noted in the RE patch graft tissue. Corneal thinning in the LE was treated topically with artificial tears and antibiotic eyedrops, which eventually healed, forming macular corneal opacity. Overall, corneal patch graft repair enabled the maintenance of tectonic support and corneal integrity, as well as vision improvement in the patient with RA presenting with the complication of corneal melt and perforation.