Management of Corneal Melting Associated with Rheumatoid Arthritis-3 Cases Reports

Abstract

Purpose: To present our experience of successful management of rheumatoid corneal melt and perforation with different strategies. Method: Case reports Results: Case 1: A 77-year-old man with rheumatoid arthritis (RA) presented large size paracentral corneal melt and perforation following pterygium excision. He underwent an emergency scleral patch graft with conjunctival flap and visual acuity improved from counting finger to 6/30 after 6 months follow up. Case 2: A 53-year-old woman presented peripheral ulcerative keratitis with small size perforation and RA was diagnosed at the same time. She was successfully treated with therapeutic contact lens (TCL) insertion. Case 3: A 70-year-old woman with RA presented paracentral corneal melt and perforation. Corneal reepithelialization was achieved within one week by emergent amniotic membrane transplantation (AMT) and therapeutic contact lens coverage. Conclusion: RA-associated corneal melting often has a poor visual outcome and may lead to corneal perforation and should be treated more aggressively. The scleral patch graft with conjunctival flap offers an effective treatment for large peripheral corneal perforation. The TCL is an alternative good choice for small corneal perforation. The AMT promotes a stable and rapid reconstruction of corneal perforations.