Management Of Pre-Perforative Peripheral Ulcerative Keratitis With Fibrin Membrane Grafting In A Rheumatoid Polyartritis Patient
Published 2024 - 42nd Congress of the ESCRS
Reference: PO878 | Type: Poster | DOI: 10.82333/w09r-t964
Authors: Fatima Zahra Kassimi* 1 , youssef harrar 1 , rihab skiker 1 , fatima zahra Mebrouki 1 , asmae maadane 1 , siham chariba 1 , rachid sekhsoukh 1
1OPHTALMOLOGY,CHU MOHAMMED VI - OUJDA,OUJDA,Morocco
Purpose
Peripheral ulcerative keratitis PUK or Mooren's pseudo-ulcers is a corneal manifestation of a general pathology like rheumatoid polyartritis.
It is an ocular inflammation involving the outer portion of the cornea, the most severe complication being corneal perforation. Its treatment is determined by the severity of the corneal damage and the activity of the vasculitis.
the aim of our work is to demonstrate one of the easiest methods available for managing perforations of corneal ulcer .
Setting
We report the case of a patient hospitalized in the Ophthalmology Department of the CHU Mohammed VI of OUJDA.
Methods
It is a 45 years old female patient treated for rheumatoid arthritis (RA) with corticotherapy and methotrexate .She consulted the ophthalmological emergency department for a painful red eye with decreased visual acuity VA, tearing and photophobia that had been evolving for 1 month since her admission.
The clinical examination showed in the left eye : VA couting fingers at 1m,a clean and preperforating marginal corneal ulcer with peripheral neovascularisation and filamentous keratitis .
Results
-The patient was hospitalized and received corticosteroid eye drops initially and then conjunctival corticosteroid injection,healing treatment,preventive
local antibiotic .A fibrin membrane graft was made from the patient's blood using a centrifuge to create fibrin rich in platelets and growth factors allowing the ulcer to heal.
-PUK is a rare but serious complication of RA and is associated with high mortality.Treatment of PUK begins with topical corticosteroid therapy.
-Systemic treatment is based on high-dose corticosteroid therapy and adjunctive treatment with immunosuppressive agents or biotherapy.
-Fibrin membrane grafting is a simple and available technique to accelerate healing due to growth factors, and also to reduce inflammation.
Conclusions
-Detection of corneal complications in inflammatory diseases is a factor in poor systemic function and prognosis, especially in the case of ulcers.
-This case confirmed the findings in the literature on the benefit of corticosteroids in the treatment of corneal ulcers secondary to peripheral ulcerative keratitis in rheumatoid arthritis.