Bristol Eye Hospital, Bristol, United Kingdom.
Cornea. 2014 Jan;33(1):27-31. doi: 10.1097/ICO.0000000000000008.
Management of noninfectious ulcerative keratitis (UK) and associated systemic disorders has changed over recent years. This study aimed to analyze a recent cohort of patients with UK in this context.
The case notes of all the patients attending a specialist corneal immunosuppression clinic between June 2002 and July 2012 were reviewed. A subgroup comparison of those with rheumatoid arthritis (RA) was made with those included in an earlier report from this same center (Malik et al. Eur J Ophthalmol. 2006;16:791-797). The Fisher exact test was used for statistical comparison, and a Bonferroni correction was applied.
Seventy patients, whose mean age was 65.0 years (median, 64 years), were included. Fifteen (21%) had bilateral disease, and forty-six had RA (66%). At presentation, the mean (median) visual acuity (VA) was 0.59 (0.18) logarithm of the minimum angle of resolution equivalent to 6/24 (6/9) Snellen. All the patients were prescribed systemic corticosteroids, which were later stopped in 45 (64%) patients. All but 2 were treated with steroid-sparing immunosuppressive agents, with each patient being prescribed a mean of 1.5 medications (range, 0-4), including prednisolone. These included prednisolone (70, 100%), methotrexate (47, 67%), mycophenolate (15, 21%), tacrolimus (5, 7%), and azathioprine (4, 6%). No irreversible side effects occurred. After perforation, 12 eyes of 11 patients (16%) underwent a corneal transplantation, and 10 (83%) of these remained clear. The mean (median) VA of the affected eyes when last seen was 0.34 (0.18) logarithm of the minimum angle of resolution equivalent to 6/13 (6/9) Snellen. The subset of patients with RA had significantly lower rates of corneal perforation and a VA ≤ 6/60 when last seen (P < 0.05) compared with that of the earlier cohort.
Ocular morbidity associated with UK has fallen, possibly because of a move toward more aggressive systemic antiinflammatory therapy.
近年来，非传染性溃疡性角膜炎（UK）及其相关系统性疾病的治疗发生了变化。本研究旨在分析在此背景下最近的 UK 患者队列。
回顾了 2002 年 6 月至 2012 年 7 月间在一家专门的角膜免疫抑制诊所就诊的所有患者的病历。对那些患有类风湿关节炎（RA）的患者进行了亚组比较，并与来自同一中心的早期报告中的患者进行了比较（Malik 等人，Eur J Ophthalmol. 2006；16:791-797）。使用 Fisher 确切检验进行统计比较，并应用 Bonferroni 校正。
共纳入 70 例患者，平均年龄为 65.0 岁（中位数为 64 岁）。15 例（21%）为双眼疾病，46 例患有 RA（66%）。就诊时，平均（中位数）视力（VA）为 0.59（0.18）对数最小角分辨率相当于 6/24（6/9）Snellen。所有患者均接受全身皮质类固醇治疗，其中 45 例（64%）患者随后停止治疗。除 2 例患者外，所有患者均接受类固醇保存免疫抑制剂治疗，每位患者平均使用 1.5 种药物（范围为 0-4），包括泼尼松龙。这些药物包括泼尼松龙（70 例，100%）、甲氨蝶呤（47 例，67%）、霉酚酸（15 例，21%）、他克莫司（5 例，7%）和硫唑嘌呤（4 例，6%）。没有发生不可逆转的副作用。穿孔后，11 例患者的 12 只眼（16%）进行了角膜移植，其中 10 只眼（83%）保持透明。最后一次就诊时受影响眼睛的平均（中位数）VA 为 0.34（0.18）对数最小角分辨率相当于 6/13（6/9）Snellen。与早期队列相比，RA 患者的角膜穿孔率和最后一次就诊时视力≤6/60 的发生率明显降低（P<0.05）。
与 UK 相关的眼部发病率有所下降，这可能是由于更积极的全身性抗炎治疗。
