Artaechevarria Artieda June, Estébanez-Corrales Nuria, Sánchez-Pernaute Olga, Alejandre-Alba Nicolás
Department of Ophthalmology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Department of Rheumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Case Rep Ophthalmol. 2020 Sep 25;11(3):500-506. doi: 10.1159/000508325. eCollection 2020 Sep-Dec.
Peripheral ulcerative keratitis (PUK) is a group of corneal disorders that cause peripheral corneal thinning, threatening globe integrity in advance stages. It is usually associated with systemic autoimmune diseases and management is based on local and systemic approaches. We present the case of a 47-year-old man with a previous history of bacterial keratitis in his left eye presenting with 1 month of bilateral ocular pain and redness. At examination, diffuse bilateral globe inflammation with paracentral corneal thinning in his left eye was observed. He was diagnosed with bilateral scleritis and PUK in his left eye. Workup for associated systemic autoimmune disease yielded negative results. The patient was started on pulses of intravenous methylprednisolone followed by oral prednisone failing to achieve sufficient control of the inflammatory syndrome. Subsequently, periodic intravenous cyclophosphamide was administered with a favorable response. A multilayer amniotic membrane graft was applied, but there was rapid melting with reabsorption of the tissue, resulting in extreme corneal thinning at the inferior paracentral cornea. A decentered 8.5-mm superficial anterior lamellar keratoplasty (SALK) was then performed obtaining the donor graft with a femtosecond laser but performing manual trepanation in the recipient. At 12 months, visual and biomicroscopic measures do not show deterioration and inflammation remains under control with oral azathioprine as maintenance regime. The management of PUK includes both systemic immunosuppression and tectonic procedures to preserve the globe integrity. Diverse surgical techniques have been attempted, but no definitive guidelines are available. Decentered large SALK is a simple technique that can yield acceptable visual results.
周边溃疡性角膜炎(PUK)是一组可导致周边角膜变薄的角膜疾病,在疾病晚期会威胁眼球完整性。它通常与全身性自身免疫性疾病相关,治疗基于局部和全身治疗方法。我们报告了一例47岁男性病例,其左眼曾有细菌性角膜炎病史,此次因双眼眼痛和眼红1个月就诊。检查时,观察到双眼弥漫性炎症,左眼旁中央角膜变薄。他被诊断为双侧巩膜炎,左眼为周边溃疡性角膜炎。相关全身性自身免疫性疾病的检查结果为阴性。患者开始静脉注射甲泼尼龙冲击治疗,随后口服泼尼松,但未能充分控制炎症综合征。随后,定期静脉注射环磷酰胺,取得了良好效果。应用了多层羊膜移植,但组织迅速溶解吸收,导致下方旁中央角膜极度变薄。然后进行了偏心8.5毫米的浅表前板层角膜移植术(SALK),用飞秒激光获取供体移植物,但在受体上进行手动环钻。12个月时,视力和生物显微镜检查未显示恶化,炎症通过口服硫唑嘌呤作为维持治疗得以控制。周边溃疡性角膜炎的治疗包括全身免疫抑制和维持眼球完整性的结构性手术。已尝试了多种手术技术,但尚无明确的指导原则。偏心大直径浅表前板层角膜移植术是一种简单的技术,可产生可接受的视觉效果。