Al Saleh Ahmed, Al Saleh Abdullah S, Al Qahtani Abdulmalik
Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Department of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Saudi J Ophthalmol. 2021 Feb 27;34(3):216-217. doi: 10.4103/1319-4534.310409. eCollection 2020 Jul-Sep.
Rheumatoid arthritis (RA) can affects many organs including the eyes. Corneal perforation in the form of peripheral ulcerative keratopathy can be debilitating and difficult to manage. A 48-year-old female with known RA presented with sudden loss of vision in her left eye, she was diagnosed with left corneal perforation secondary to severe dry eye. Penetrating keratoplasty (PKP) and punctum occlusion were done. Amniotic membrane transplant (AMT) was done 1 month later due to nonhealing epithelial defect. Her RA was clinically inactive, and no changes in her current medications were made. However, 4 months later, she presented with a second corneal perforation with melting. She had another PKP and AMT with permanent temporal tarsorrhaphy. Cyclosporine 100 mg P. O. twice daily was added, but after 5 months, she presented again with a third left corneal perforation with melting. Again, PKP and AMT with tarsorrhaphy were done, and she was started on infliximab. Since then, she had a stable graft with no further corneal perforations. In summary, patients with RA can have corneal perforations even if other signs of RA are absent. If the systemic treatment that is used to treat RA fails, one should consider using other classes of drugs, such as monoclonal antibodies (e.g., rituximab), tumor necrosis factor alpha blockers (such as infliximab or adalimumab), interleukin (IL)-1 receptor antagonists (e.g., anakinra), or IL-6 receptor antagonist (e.g., tocilizumab).
类风湿关节炎（RA）可累及包括眼睛在内的许多器官。外周溃疡性角膜炎形式的角膜穿孔可能使人衰弱且难以处理。一名48岁已知患有RA的女性因左眼突然失明就诊，她被诊断为继发于严重干眼的左眼角膜穿孔。实施了穿透性角膜移植术（PKP）和泪点封闭术。由于上皮缺损未愈合，1个月后进行了羊膜移植（AMT）。她的RA在临床上处于非活动期，当前用药未作改变。然而，4个月后，她出现了第二次角膜穿孔并伴有角膜溶解。她再次接受了PKP和AMT，并进行了永久性颞侧睑裂缝合术。加用了环孢素100毫克口服，每日两次，但5个月后，她又出现了第三次左眼角膜穿孔并伴有角膜溶解。再次实施了PKP和AMT以及睑裂缝合术，并开始使用英夫利昔单抗治疗。从那时起，她的移植片保持稳定，未再出现角膜穿孔。总之，即使没有RA的其他体征，RA患者也可能发生角膜穿孔。如果用于治疗RA的全身治疗失败，应考虑使用其他类别的药物，如单克隆抗体（如利妥昔单抗）、肿瘤坏死因子α阻滞剂（如英夫利昔单抗或阿达木单抗）、白细胞介素（IL）-1受体拮抗剂（如阿那白滞素）或IL-6受体拮抗剂（如托珠单抗）。
