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Severe bilateral peripheral ulcerative keratitis

Poster Details

First Author: L.Mariñas Garcia SPAIN

Co Author(s):    B. Garcia Valcarcel Gonzalez   R. Vera Echevarria   A. Baeza Autillo   P. Balado Vazquez           

Abstract Details

Purpose:

To report a case of bilateral peripheral ulcerative keratitis that deteriorated despite of systemic corticosteroids therapy.

Setting:

Corneal and Surface Ocular Section. Gregorio Marañon General University Hospital. Madrid. Spain

Methods:

A 39 year old female presented with asymmetric bilateral peripheral ulcerative keratitis. Patient´s history includes suppurative hidrosadenitis, hypergammaglobulin Ig G and Ig A and lynphopenia. The patient presented pain, redness, photophofia and diminution of vision of the left eye (LE) during one week. The best corrected visual acuity (BCVA) was 20/25 and 20/40 in right (RE) and LE respectively. Slit -lamp examination LE showed a peripheral epithelial defect extending to four areas, crescent shape stromal inflammation with a 10-20% of peripheral thinning and the features suggestive of Mooren's ulcer with adjacent episcleritis. There was a sectorial corneal opacity in RE.

Results:

The condition improved with systemic steroids, cyclosporine A, autologous serum eye drops and topical and systemic antibiotics. Two years later, a 50% peripheral thinning from 6 to 8 hours with slight vascularization was note in the right eye and, in the left, areas with corneal thinning of 75%. It presented an overhanging edge overlying central and leading edge that started in the periphery and spread centrally and circumferentially. Topography showed 3 dioptric astigmatism in the left eye. Inmunologist suggested inmunosupressive theraphy as long term treatment. After two months follow up, ulcer had healed, the vascularization had decreased but the dangerous thinning continued. Reason why a strict control is required.

Conclusions:

Peripheral ulcerative keratitis (PUK) is characterized by crescent-shaped destructive inflammation of the juxtalimbal corneal stroma, epithelial defect and progressive stromal degradation that can leads to perforation. Collagen vascular diseases, systemic or local infectious and noninfectious local disorders as Mooren’s ulcer may cause PUK. The mainstay of medical management is topical steroids, profilactic antibiotics and artificial tears as a complement. Tetracycline also can be used. In malignant cases, systemic corticosteroid should be added. In cases of extensive involvement or bilateral relentlessly progressive ulcer not responding to previous therapeutic modalities, systemic immunosuppression and appraisal by other specialties (Rheumatology, Immunology) should be considered.

Financial Disclosure:

NONE

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