Peripheral Ulcerative Keratitis Research Articles

Clinical presentation and outcomes of Mooren’s ulcer: a 2-year retrospective cohort study

Background: Mooren’s ulcer is a chronic, painful, unrelenting, peripheral ulcerative keratitis with atypical geographic presentation and distribution. This study aimed to retrospectively investigate the clinical presentation and outcomes of patients with Mooren’s ulcer over a 2-year period at the Evangelical Church Winning All (ECWA) Eye Hospital, Kano, Nigeria. Methods: The theatre records of 24 patients with Mooren’s ulcer were retrospectively reviewed, with a focus on those who had up to 2 years of follow-up. The surgical treatment followed a standard procedure of 3 ml of 2% xylocaine and 0.01% adrenaline were administered for peribulbar anaesthesia. The periorbital area was cleaned with 10% povidone iodine, draped, and a lid speculum was inserted to part the lids. The conjunctiva was excised 2 mm from the edge of the ulcer, and the area was lightly cauterized. This was followed by a combination of subconjunctival injection of 2 mg of dexamethasone and 20 mg of gentamycin and a drop of 0.3% of ciprofloxacin and 1% of atropine. Data were analyzed using a social science statistical package (IBM SPSS Inc. Chicago V 19.0) with 95% confidence. Results: The results revealed that Mooren’s ulcer was predominant in an age range of 11 and 30 years. A total number of 24 patients were seen in the two years of review, with an average age of 27.3±13.7 years. There were 19 male and 5 female patients, with a male-to-female ratio of 3.8:1. At presentation, patients had poor preoperative vision, with acuity values of less than 6/60–3/60 range. Postoperatively, 15 eyes had a borderline outcome (cannot see 6/18 but can see 6/60), 12 eyes had good vision (VA 6/18) and 4 eyes ended up with the same presenting vision (VA<6/60) after treatment. One patient had iris prolapse and three patients had evisceration. Conclusions: This study provided the clinical characteristics of patients with Mooren’s corneal ulcer. A comparison of preoperative and postoperative visual acuity showed that early presentation and intervention improved visual outcomes. Although most eyes maintained or improved vision, nearly half demonstrated a borderline result that fell short of the target vision threshold. The retrospective nature of this study limited its ability to review complete patient information. The small sample size also constrained the analysis due to the low incidence of Mooren’s ulcer. Further research is needed to better understand increased susceptibility in younger populations. This will help inform prevention and treatment efforts to address this public health challenge.

P109 Ocular manifestation of rheumatoid arthritis

Abstract Background/Aims Ocular manifestation associated with rheumatoid arthritis (RA) is common and should be systematically investigated by an ophthalmological examination. It may precede or complicate the disease. It manifests as a dry-eye syndrome in 38% to 45% of cases, scleritis in 0.2 to 6.3% of cases, episcleritis in 0.17 to 3.7% of cases, and peripheral ulcerative keratitis in 3% of cases. The aim of this study was to describe ocular involvement in RA and to identify factors predictive of its occurrence. Methods This is a retrospective study of patients with RA defined according to the ACR- EULAR 2010 criteria, followed up in the internal medicine department between 2015 and 2022. Patients were divided into two groups: G0 including patients without ocular involvement and G1 including patients with ocular involvement. Results Eighty patients were diagnosed, 65 women and 15 men, giving a sex ratio (F/H) of 4.33. The mean age was 60.79 years [extremes: 30-90 years]. The mean age of disease onset was 46.34 years [extremes: 22-82 years]. Among our 80 patients, 20 had RA-related ocular involvement (25%). These included 18 women and two men. Ocular involvement consisted of dry-eye syndrome (17 cases), superficial punctate keratitis (4 cases), corneal perforation (one case), and unilateral diffuse scleritis (one case). The ocular examination had also revealed corticosteroid adverse effects: corticosteroid-induced cataract (four cases) and corticosteroid-induced glaucoma (three cases). Sjogren’s syndrome associated with RA was present in 76.47% of cases. There was no difference between the two groups in terms of age (62.25 vs. 44.22 years, p = 0.943), age of disease onset (47, 23 years vs. 44.22 years, p = 0.569), rheumatoid factor level (335.29 IU/L vs. 329.15 IU/L, p = 0.393) and anti-CCP antibody level (225.08 IU/L vs. 119.23 IU/L, p = 0.070). CRP was significantly higher in patients with no ocular involvement (225.08 mg/l vs. 118.23 mg/l, p = 0.007). erosive character was observed more in G0 than in G1, but without any significant difference, respectively 85.29% vs. 68.42%; p = 0.146. Conclusion According to our study, a quarter of patients followed for RA had ocular manifestations dominated mainly by dry syndrome. However, no predictive risk factor was found for this condition, be it clinical, immunological, or radiological. Disclosure I. Fenniche: None. Z. Aydi: None. M. Somai: None. F. Daoud: None. B. Ben dhaou: None. S. Kochbati: None. I. Rachdi: None. F. Boussema: None.

Peripheral ulcerative keratitis associated with tralokinumab therapy: a case report and review of IL-13 inhibitor-associated ocular surface disease

BackgroundDupilumab and tralokinumab are interleukin-binding monoclonal antibodies used to treat systemic atopic disease. Use of these medications in management of atopic dermatitis (AD) is known to cause conjunctivitis. Dupilumab therapy has also been associated with more severe ocular surface disease, which has not previously been described in association with tralokinumab. This report describes a case of tralokinumab-associated conjunctivitis and peripheral ulcerative keratitis and reviews the spectrum and proposed mechanisms of ocular surface disease triggered by these medications.Case presentationA 61-year-old male with no rheumatologic or ocular history presented with bilateral papillary conjunctivitis and right eye peripheral ulcerative keratitis (PUK). PUK was arrested using oral corticosteroids and doxycycline, and long-term control of papillary conjunctivitis was achieved using topical tacrolimus ointment, allowing continuation of effective AD management with tralokinumab.ConclusionThis case report documents ulcerative keratitis occurring in association with tralokinumab therapy for AD, which has previously been described with dupilumab but not tralokinumab. This report demonstrates the need for vigilant ocular surface monitoring for patients on tralokinumab and illustrates successful management and long-term control of adverse ocular events associated with this medication.

Demographic Characteristics, Clinical Presentations, and Risk Factors Impacting Visual Outcomes in Peripheral Ulcerative Keratitis.

To assess the demographic characteristics, ophthalmic and systemic presentations, and risk factors impacting the outcomes in patients diagnosed with peripheral ulcerative keratitis (PUK). This retrospective study includes patients diagnosed with PUK at a tertiary care center over 13 years. A descriptive analysis of the demographics, clinical history, and presentation was performed. A reverse risk analysis was performed to assess the PUK resolution in patients with underlying autoimmune and non-autoimmune etiologies. Finally, we evaluated the correlation between treatment duration and final best corrected visual acuity (BCVA) and continuous and categorical variables. A total of 58 eyes of 51 patients with a mean age of 59.67 ± 13.41 years diagnosed with PUK were included in the study; 58.82% were female. The resolution duration was significantly shorter in patients with autoimmune etiologies (vs. non-autoimmune etiologies, P = 0.028) and female patients (vs. male patients, P = 0.008). The BCVA worsened in patients with non-autoimmune etiologies after treatment (P = 0.17). Despite worse BCVA at presentation in patients with underlying autoimmune etiologies, significantly better final vision outcomes were observed (P = 0.04). Linear regression analysis showed that longer treatment duration (P = 0.001; R2 = 0.1704) and worse vision (P = 0.002; R2 = 0.1502) at presentation were the primary risk factors of poor vision outcomes. Similarly, the treatment duration was significantly longer in male compared with female patients (P < 0.001; R2 = 0.2027). The clinical outcomes in PUK with underlying autoimmune disorders were observed to be better than non-autoimmune etiologies, which may be attributed to the early detection of the PUK-related changes and aggressive medical management. A delayed diagnosis of PUK leads to poor vision outcomes.

Intravenous cyclophosphamide therapy for patients with severe ocular inflammatory diseases who failed other immunomodulatory therapies

BackgroundOcular inflammatory diseases, including scleritis and uveitis, have been widely treated with immunomodulatory therapies (IMTs) as a steroid-sparing approach. Such strategy includes conventional therapies (antimetabolites, alkylating agents, and calcineurin inhibitors) as well as biologic agents like adalimumab, infliximab, rituximab, and tocilizumab. Cyclophosphamide (CP) is an alkylating agent and mainly inhibits the functioning of both T and B cells. Though known to have potential adverse events, including bone marrow suppression, hemorrhagic cystitis, and sterility, CP has been shown to be efficacious, especially in recalcitrant cases and when used intravenous (IV) for a limited period.Main findingsWe conducted a retrospective case-series to assess the safety and efficacy of CP therapy for patients with severe ocular inflammatory diseases who failed other IMTs. Medical records of 1295 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were reviewed. Seven patients (10 eyes) who received CP therapy for ocular inflammatory diseases with at least one year of follow-up were included. The mean age of the patients (4 males, 3 females) was 61.6 ± 14.9 (43.0–89.0) years. Clinical diagnoses included necrotizing scleritis (5 eyes), peripheral ulcerative keratitis (2 eyes), orbital pseudotumor (1 eye), HLA-B27 associated panuveitis and retinal vasculitis (2 eyes). Ocular disease was idiopathic in 3 patients, and was associated with rheumatoid arthritis, IgG-4 sclerosing disease, dermatomyositis, and ankylosing spondylitis in 1 patient each. All the patients had history of previous IMT use including methotrexate (5), mycophenolate mofetil (3), azathioprine (1), tacrolimus (1), adalimumab (2), infliximab (4), and rituximab (1). The mean follow-up time was 34.4 ± 11.0 (13–45) months, and mean duration of CP therapy was 11.9 ± 8.8 (5–28) months. Remission was achieved in 5 patients (71.4%). Four patients (57.1%) experienced transient leukopenia (white blood cell count < 4000/mL).Short conclusionCP therapy can be considered a potentially effective and relatively safe therapeutic option for patients with severe ocular inflammatory diseases who failed other IMTs including biologics (TNFa and CD20 inhibitors).

Persistent and Severe Mpox Keratitis Despite Systemic and Topical Treatment.

The purpose of this study was to report a case of peripheral ulcerative keratitis in a patient diagnosed with corneal polymerase chain reaction (PCR) and a positive mpox culture. This is a case report. An immunocompetent 54-year-old man was diagnosed with conjunctivitis in his left eye 15 days after being diagnosed with mucocutaneous monkeypox. He received treatment with dexamethasone 0.1% and tobramycin 0.3% eye drops for 2 weeks. Two weeks after discontinuing this treatment, he developed peripheral ulcerative keratitis and a paracentral epithelial defect. Mpox keratitis was diagnosed by corneal culture and PCR. Corneal inflammation persisted for more than 6 months, manifested as corneal epithelial defect, limbitis, endotheliitis, neurotrophic changes, and trabeculitis. This persistence was observed alongside positive corneal PCR results, despite undergoing 2 courses of trifluorothymidine, 2 courses of oral tecovirimat, and intravenous cidofovir. An amniotic membrane transplantation was then performed. Persistent corneal pain and replication are possible with the mpox virus, even in immunocompetent patients. Having received treatment with topical corticosteroids before antiviral treatment for the pox virus may have contributed to the severity and persistence of the clinical condition. Cycle threshold PCR values can be used to support the diagnosis and monitor treatment effectiveness.

Unilateral Mooren Ulcer After COVID-19 Vaccination

Introduction: Mooren ulcer is an immune-related corneal pathology of unknown origin, that often occurs following a triggering factor. Case Report: We report the case of a 32-year-old woman who presented with a red painful right eye. The clinical findings were in favor of peripheral ulcerative keratitis. The etiological assessment came back negative. The retained diagnosis was Mooren ulcer. The treatment was based on oral corticosteroid therapy and immunosuppressants prescribed by internists. The evolution was marked by the regression of the pain and the stability of the lesion. Discussion: Currently in the literature, rare cases of corneal ulcers following COVID-19 vaccination have been described. A causal link remains possible but not yet proven. This subject needs more perspective and research. Conclusion: The COVID-19 vaccine has several ocular side effects. The mechanism of triggering a mooren ulcer remains unclear.

Peripheral Ulcerative Keratitis: A Serious Corneal Inflammation

Abstract&#x0D; Introduction : Peripheral ulcerative keratitis (PUK) is a rare, but severe sight-threatening inflammatory condition that affects the cornea. PUK is characterized by peripheral corneal ulceration, stromal thinning, and neovascularization that can lead to corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders.&#x0D; Case Illustration : A 53-year-old woman presented to the ophthalmology clinic with complaints of redness, foreign body sensation, and blurred vision in her both eye for the past three days. On examination, slit-lamp biomicroscopy revealed a peripheral corneal ulcer. She had a history of rheumatoid arthritis for the past 2 months and was being treated with methotrexate and metylprednisolone. Laboratory investigations revealed elevated Anti-CCP IgG, which confirmed the presence of rheumatoid arthritis.&#x0D; Discussion : PUK is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis, but may also occur in individuals with infectious, degenerative or traumatic corneal injuries. Immune- mediated inflammation, complement activation, and tissue destruction are thought to be involved in the pathogenesis of PUK. The diagnosis of PUK requires a thorough ophthalmic examination, including slit-lamp biomicroscopy, and laboratory investigations for underlying autoimmune disorders.&#x0D; Conclusion : PUK is a rare but serious ocular disease that requires prompt diagnosis and management to prevent severe complications such as corneal perforation and vision loss. Although PUK can occur in individuals without underlying systemic disease, it is most commonly associated with autoimmune disorders, particularly rheumatoid arthritis.

Devastating Mooren Ulcer Halt by Timely Aggressive Treatment - A Case Report

Introduction : Mooren ulcer is a progressive and painful peripheral ulcerative keratitis of unknown cause. Study aims to show effective aggressive treatment for Mooren ulcer.&#x0D; Case Illustration : A 43-year-old man was admitted with a marked clinical worsening of the white tissue covering the cornea, accompanied by pain, redness, and blurry vision of the left eye. Initial examination showed visual acuity of 6/21cc. Peripheral corneal ulcer was found from 6 to 2 clock hours with superficial vascularization and epithelial defect. Patient underwent ancillary examinations with unremarkable findings. Patient was diagnosed with Mooren Ulcer and treated with artificial tears and steroid topical. Patient had no significant improvement; therefore conjunctival resection with immunosuppressive therapy were performed. At follow up, no pain was reported, vision improved to 6/15cc, and the ocular surface inflammation resolved.&#x0D; Discussion : Mooren ulcer is usually misdiagnosed since the clinical signs are similar to other differential diagnoses. The examination must be performed carefully to rule out autoimmune and corneal infection. Treatment goals are to halt the destructive process and promote reepithelization. The stepwise aggressive approach of Mooren Ulcer treatments is crucial. It starts directly with topical steroid to control the progression of inflammation. However, when used alone, topical steroid usually cannot prevent the rapid progression so conjunctival resection is needed to remove the source of collagenase production by cutting the perilimbal blood vessels’ access to the area of the ulcer. Combination with an immunosuppressant will effectively maintain a stable condition.&#x0D; Conclusion : Early diagnosis and aggressive treatment for Mooren ulcer are needed to prevent the rapid progression.

Ocular manifestations of granulomatosis with polyangiitis: report from a tertiary eye care center.

To report demographic characteristics and ophthalmological manifestations of patients with granulomatosis with polyangiitis (GPA) in a tertiary eye care center in Turkey. Medical records of patients with GPA-related ocular manifestations evaluated between 2013 and 2023 were included. Demographic and clinical characteristics of the patients including nature of systemic involvement, ophthalmologic symptoms and signs, laboratory investigations and treatment modality were reviewed. Twelve eyes of 10 patients (5 female/5 male) were included. The mean age was 57.2 ± 12.2 (35-71) years. Five (50%) patients were already diagnosed with GPA. Ocular involvement was the first manifestation of GPA in 3 patients. The remaining 2 patients had simultaneous systemic and ocular symptoms at presentation. Conjunctival hyperemia (9 eyes) and pain (7 eyes) were the most frequent presenting symptoms followed by blurred vision (3 eyes). The frequencies of ocular manifestations were as follows:episcleritis (3 eyes), isolated peripheral ulcerative keratitis (PUK) (3 eyes), scleritis (3 eyes), simultaneous PUK and scleritis (2 eyes) and periorbital mass (1 eye). Ophthalmological manifestations can be the initial findings in GPA. Since GPA can affect different structures of the eye, it sometimes might be challenging for ophthalmologists. Therefore, it is crucial for ophthalmologists to be well-informed about GPA-related ocular findings and to have a high index of suspicion for GPA. Although PUK associated with scleritis is highly suggestive for GPA, isolated cases of PUK or scleritis can be seen in GPA. Therefore, it is important to adopt a multidisciplinary approach, consider GPA in differential diagnosis, and benefit from accurate diagnostic tests.

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

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.

Amniotic Membrane Transplantation-A Surgical Alternative in Peripheral Ulcerative Keratitis

Introduction: Peripheral ulcerative keratitis (PUK) is a group of inflammatory corneal ulcers with stromal thinning and peripheral localization. It begins with immune cellular infiltrates in the juxtalimbal cornea, followed by a crescent-shaped ulcer that appears parallel to the limbus. Medical management includes intense lubrication, antibiotics, along with topical and systemic steroids and immunosuppressants. Definitive surgical management is lamellar patch or penetrating corneal graft. Amniotic membrane has wide array of biological properties, including anti-inflammatory, anti-bacterial, anti-angiogenic, antifibrotic, healing properties hence can be used as an alternative to keratoplasty. Material and Methods: This mono institutional observational retrospective study was conducted on 15 eyes of 15 patients having PUK in a tertiary health care centre. Patients underwent single-layered amniotic membrane transplantation (AMT) in case of corneal thinning involving &lt;1/2 corneal stroma, multi-layered or rolled AMT in cases of corneal thinning involving &gt;1/2 corneal stroma or with moderate to large perforations along with systemic steroids and immunosuppression. Results: All 15 Patients (100%) initially had symptomatic relief,2 patients (13.33%) underwent repeat AMT (86%success rate), 2 failures were noted, out of which 1 patient (6.67%) underwent corneal patch graft while 1 patient (6.67%) underwent large penetrating keratoplasty which failed and landed in Phthisis. Conclusion: AMT is a safe and effective alternative for the surgical management of PUK in combination with local and systemic immunosuppressive therapy. A close collaboration between the ophthalmologist and the physician is mandatory to prevent corneal perforation and decrease patient morbidity and risk of mortality

[Allergic and immunopathological diseases of the ocular surface].

Allergic and immunopathological diseases of the ocular surface are inflammations that can occur with mild to severe symptoms that cause visual impairment. Allergic inflammations mainly affect the conjunctiva, causing acute and/or chronic conjunctivitis. Several forms are distinguished: seasonal allergic conjunctivitis, vernal conjunctivitis, atopic keratoconjunctivitis, contact allergy, giant papillary conjunctivitis. The most common is the seasonal form, which is linked to seasons. Allergic ocular surface processes require local treatment with artificial tears, anti-allergic eye drops. If complications occur, topical corticosteroid and cyclosporin treatment may be used. Immunopathological inflammations of the ocular surface are associated with systemic diseases. Keratoconjunctivitis sicca, although occurring in the absence of systemic disease, is a common companion of Sjögren's syndrome and collagen diseases. Ocular pemphigoid belongs to the group of mucous membrane pemphigoids. After the initial conjunctivitis symptoms, subconjunctival fibrosis begins, leading to the development of sym- and ankyloblepharon. In the final stage, the ocular surface is covered by scar tissue (ocular cicatricial pemphigoid) which practically results in loss of vision. Peripheral ulcerative keratitis is usually associated with collagen vascular disease, rheumatoid arthritis. A 3-4 mm long, curved infiltration starting near the limbus becomes ulcerated and then perforates, on which the iris may prolapse. First, systemic treatment is required, which is an interdisciplinary task. Topical corticosteroid and cyclosporine eye drops may be administered. In the case of corneal perforation, amniotic membrane transplantation and/or keratoplasty may be performed. Orv Hetil. 2023; 164(43): 1686-1692.

Case report peripheral ulcerative keratitis with nodular scleritis, presents as the primary manifestation of granulomatosis with polyangiitis.

A 38-year-old female complaining of recurrent deep boring pain with redness in her left eye for many years, which was diagnosed as nodular scleritis with peripheral ulcerative keratitis. The patient also has recurrent bouts of epistaxis and in suspicion of GPA laboratory investigations were carried out and later diagnosed. She was started on cyclophosphamide and is currently under maintenance with rituximab. Ocular involvement has been shown to occur in 20-50% of the population in several studies. It causes conjunctivitis, episcleritis, scleritis, necrotizing keratitis, corneoscleral perforation, posterior uveitis, and optic neuritis. The positive C-ANCA and high PR3 autoantibody have high sensitivity and association with GPA. Cyclophosphamide has been shown to be an effective treatment in multiple studies whereas rituximab has been emerging as a new treatment modality for maintenance, which in turn helps in the remission and relapse of GPA cases. Scleritis and peripheral ulcerative keratitis can be the manifestation of a GPA. Careful evaluation, diagnosis, and management with a multidisciplinary medical team, early start of cyclophosphamide, and rituximab have a huge role in decreasing the disease activity and is life-saving.

Peripheral ulcerative keratitis as the first and only manifestation of MPO-ANCA-associated vasculitis.

Journal Article Accepted manuscript Peripheral ulcerative keratitis as the first and only manifestation of MPO-ANCA-associated vasculitis Get access Ana Paula Couto, Ana Paula Couto Department of Ophthalmology, Hospital Universitario Antonio Pedro, Fluminense Federal University (UFF), Niteroi, Brazil Contact Information: Ana Paula Couto, 132 Desembargador Izidro Street, apt 504A, Rio de Janeiro, R.J., 20521–160, Brazil. Email address: anapaulacouto1@hotmail.com. https://orcid.org/0000-0002-7796-7688 Search for other works by this author on: Oxford Academic PubMed Google Scholar Verônica Mello, Verônica Mello Department of Clinical Medicine, Hospital Universitario Gaffrée e Guinle, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil Search for other works by this author on: Oxford Academic PubMed Google Scholar Gabriel Conde Motta, Gabriel Conde Motta Department of Ophthalmology, Hospital Universitario Antonio Pedro, Fluminense Federal University (UFF), Niteroi, Brazil Search for other works by this author on: Oxford Academic PubMed Google Scholar Bruno F Fernandes, Bruno F Fernandes I2 Vision, San Diego, CA, United States Search for other works by this author on: Oxford Academic PubMed Google Scholar Carolina Vieira Carolina Vieira Department of Ophthalmology, Hospital Universitario Antonio Pedro, Fluminense Federal University (UFF), Niteroi, Brazil Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, kead218, https://doi.org/10.1093/rheumatology/kead218 Published: 19 May 2023 Article history Received: 02 March 2023 Revision received: 18 April 2023 Accepted: 03 May 2023 Published: 19 May 2023

Diagnosis and treatment of corneal ulcers in the course of systemic autoimmune diseases

Peripheral ulcerative keratitis is an inflammatory condition, usually crescent shaped and occurring in the corneal stromal region, where it is always associated with corneal stromal thinning. Peripheral ulcerative keratitis often occurs in the course of rheumatic diseases but is most commonly associated with rheumatoid arthritis. Peripheral ulcerative keratitis is also seen in granulomatosis with polyangiitis, polyarteritis nodosa, relapsing chondritis, and systemic lupus erythematosus. These diseases are analyzed in the article in relation to peripheral ulcerative keratitis with a discussion of individual treatment methods in specific cases.

Peripheral ulcerative keratitis in a child – An unusual presentation

Peripheral ulcerative keratitis (PUK) is an inflammatory disorder of the cornea characterized by crescent-shaped destructive inflammation of the juxtalimbal corneal stroma with the associated epithelial defect. It leads to progressive necrosis of corneal stroma leading to perforation and blindness. Since PUK is more common in people with collagen vascular disorders, it is more common in middle-aged females. We discuss a unique case of a 6-year-old male child who presented as a unilateral PUK. Systemic investigations were inconclusive of any cause. The child was treated with medical therapy in the form of topical steroids and an immunomodulator, to which he responded well.

Peripheral ulcerative keratitis in a patient with systemic lupus erythematosus: A rare but devastating association

Peripheral ulcerative keratitis in a patient with systemic lupus erythematosus: A rare but devastating association

Management of perforated peripheral ulcerative keratitis (PUK-Mooren’s ulcer) with iris prolapse study in two cases

Aim: The aim of this study was to describe the management of two cases of perforated peripheral ulcerative keratitis (PUK-Mooren’s ulcer) with iris prolapse by using dried sclero-corneal patch graft and subsequently replacing donor sclero-corneal patch graft. Methods: After sectoral conjunctival resection, ulcer margin excision, and prolapsed iris excision, preserved dried sclero-corneal tissue is fashioned, and patch grafting is done as an emergency. After getting the donor sclerocorneal rim, it was again fashioned (matching the size and removal of Descemet’s membrane) and replaced the dried scleral patch graft followed by a bandage contact lens. Results: Eleven to 16 months after their initial evaluation, these patients still had some useful vision and selfsatisfaction. Conclusion: A dried sclera-corneal patch graft could be a satisfactory option in the temporary management of perforated PUK with iris prolapse until donor tissue is available. This patch graft prevents hypotony, posterior synechiae, and secondary glaucoma.

Bilateral peripheral ulcerative keratitis: A rare presentation of pediatric Behçet's disease

Bilateral peripheral ulcerative keratitis: A rare presentation of pediatric Behçet's disease