Gottsch J D, Akpek E K
Cornea and External Disease Service, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Trans Am Ophthalmol Soc. 2000;98:81-7; discussion 87-90.
To report the successful use of topical cyclosporin for treatment of central sterile corneal ulcers associated with rheumatoid disease.
Retrospective, noncomparative case series.
PARTICIPANTS/INTERVENTION: Five patients (7 eyes) with collagen vascular disorders presented with central, sterile corneal ulcers. An extensive medical evaluation did not reveal active underlying rheumatoid disease in any patient. Inadequate clinical response with use of topical steroids and lubricants led to corneal perforations requiring multiple tectonic procedures. Systemic immunosuppressive therapy either could not be initiated owing to a systemic contraindication or was discontinued owing to intolerance and side effects. The patients were ultimately treated with topical cyclosporin.
Six of the 7 eyes responded favorably. An intense limbal vascularization began within 48 hours of treatment. The neovascularization progressed centrally with the simultaneous arresting of epithelial and stromal ulceration. Over a 2-week period, re-epithelization occurred with vascularization proceeding throughout the cornea. After several months, the corneal vessels attenuated, and all signs of inflammation subsided. Intrastromal bleeding with corneal blood staining occurred in 1 patient; this resolved over several months. No recurrences of corneal ulceration occurred in a mean follow-up period of 28 months (range, 7 to 60 months). None of the 5 patients have had a reactivation of their rheumatoid disease in the follow-up period.
The clinical response in these patients contrasts with previous animal studies demonstrating an anti-angiogenic property of cyclosporin. We report that an immediate intense neovascularization is the first sign of a favorable clinical response. Treatment with topical cyclosporin alone may be considered in patients with sterile corneal ulcers associated with rheumatoid disease in the absence of systemic activation.
报告局部应用环孢素成功治疗与类风湿疾病相关的中央无菌性角膜溃疡。
回顾性、非对照病例系列。
参与者/干预措施：5例（7只眼）患有胶原血管疾病的患者出现中央无菌性角膜溃疡。广泛的医学评估未发现任何患者有活动性潜在类风湿疾病。局部应用类固醇和润滑剂临床反应不佳导致角膜穿孔，需要多次进行角膜重建手术。由于全身禁忌证无法开始全身免疫抑制治疗，或因不耐受和副作用而停药。这些患者最终接受了局部环孢素治疗。
7只眼中的6只反应良好。治疗后48小时内开始出现强烈的角膜缘血管化。新生血管向中央进展，同时上皮和基质溃疡停止。在2周内，角膜上皮化，血管化贯穿整个角膜。几个月后，角膜血管变细，所有炎症迹象消退。1例患者发生基质内出血伴角膜血染，数月后消退。平均随访28个月（范围7至60个月），角膜溃疡无复发。5例患者在随访期间类风湿疾病均未复发。
这些患者的临床反应与先前证明环孢素有抗血管生成特性的动物研究结果相反。我们报告立即出现强烈的新生血管化是良好临床反应的首个迹象。对于无全身疾病活动的与类风湿疾病相关的无菌性角膜溃疡患者，可考虑单独局部应用环孢素治疗。
