[Tectonic keratoplasty in perforated corneal ulcer in Sjögren's syndrome (report of 10 eyes in 8 patients)].

The authors report on eight patients with perforated corneal ulcers (six unilateral, two bilateral) and Sjögren's syndrome associated with rheumatoid arthritis. Five patients were evaluated serologically at the time of perforation. Circulating immune complex-like material, positive latex and Waaler-Rose tests, C-reactive protein and pathologic complements C3 and C4 were found in all patients. One patient with features clinically similar to those seen in the patients with Sjögren's syndrome had an iridocyclitis associated with HLA-B 27, with circulating immune complexes but negative latex and Waaler-Rose tests. Penetrating keratoplasty was performed in three eyes, eccentric keratoplasty in one, a penetrating mini-keratoplasty in four, and a tectonic sclerokeratoplasty in three. The keratoplasties had to be repeated in one case after ten years because of endothelial decompensation, in another case three months postoperatively because of a bacterial corneal ulcer, and in a third for optical reasons. After follow-up periods of between 12 and 1 1/4 years it was established that even though the interventions were sometimes extensive, the prognosis was good provided rheumatologic check-ups were thorough.