Trese Matthew, Schimmel Olivia, Gupta Chirag
Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Am J Ophthalmol Case Rep. 2021 Feb 5;21:101031. doi: 10.1016/j.ajoc.2021.101031. eCollection 2021 Mar.
To report a case of corneal perforation secondary to an extensive rheumatologic corneal melt, that was successfully managed via systemic immunosuppression and internal tectonic endothelial keratoplasty (TEK).
A 55-year-old male with undiagnosed rheumatoid arthritis presented with a progressively enlarging area of peripheral ulcerative keratitis with extensive keratolysis which subsequently perforated despite treatment with oral steroids. The structural integrity of the globe was restored via a combination of cyanoacrylate glue and tectonic endothelial keratoplasty (TEK). This technique provided long term structural support and improved visual acuity.
TEK grafts represent a viable treatment option in a subset of patients with corneal perforation secondary to an extensive corneal melt. The familiarity and relative ease of the surgical technique along with a lack of corneal sutures represents an alternate technique when compared to full thickness or lamellar keratoplasty. Further, through the use of anterior segment spectral domain optical coherence tomography (SD-OCT) we demonstrate that the donor graft integrated within the host cornea. To our knowledge, this represents the first case in the literature of corneal perforation secondary to an inflammatory corneal melt that was successfully managed with internal tectonic endothelial keratoplasty.
报告一例因广泛的风湿性角膜溶解继发角膜穿孔的病例，该病例通过全身免疫抑制和内界膜支撑性内皮角膜移植术（TEK）成功治疗。
一名55岁未确诊类风湿性关节炎的男性患者，出现周边溃疡性角膜炎区域逐渐扩大，伴有广泛的角膜溶解，尽管接受口服类固醇治疗，随后仍发生穿孔。通过氰基丙烯酸酯胶水和内界膜支撑性内皮角膜移植术（TEK）相结合的方法恢复了眼球的结构完整性。该技术提供了长期的结构支撑并提高了视力。
TEK移植是继发于广泛角膜溶解的角膜穿孔患者亚组中的一种可行治疗选择。与全层或板层角膜移植相比，该手术技术为人熟知且相对简便，并且无需角膜缝线，是一种替代技术。此外，通过使用眼前节谱域光学相干断层扫描（SD-OCT），我们证明供体移植物整合于宿主角膜内。据我们所知，这是文献中首例通过内界膜支撑性内皮角膜移植术成功治疗继发于炎性角膜溶解的角膜穿孔病例。
