Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom .
Cornea. 2022 Aug 1;41(8):981-985. doi: 10.1097/ICO.0000000000002854. Epub 2021 Sep 27.
We report, for the first time, 2 cases of corneal ulceration and perforation after treatment with dupilumab for atopic dermatitis.
A 30-year-old woman and a 44-year-old man developed unilateral severe corneal ulceration and perforation while on dupilumab therapy after 3 and 9 months, respectively.
Corneal cultures were negative in both cases except for scanty growth of Staphylococcus species on enrichment. Both cases progressed to perforation despite intensive topical antibiotic treatment. The first case required a tectonic keratoplasty to restore globe integrity after failed attempts of corneal gluing and multilayer amniotic membrane transplantation, and the second case was managed successfully with a cyanoacrylate glue patch.
Although there have been previous reports of conjunctival injection and dry eye after dupilumab, these are the first 2 reports of corneal ulceration with rapid progression to perforation in patients under treatment with dupilumab. The underlying pathophysiology for ulcerative keratitis in these cases remains unknown, but there is no doubt that cessation of dupilumab prevented progression of the melting. Severe ocular symptoms while on dupilumab require a prompt discussion with the dermatology team to potentially switch treatment and halt further keratitis progression.
我们首次报告了 2 例特应性皮炎患者在接受度普利尤单抗治疗后发生角膜溃疡和穿孔的病例。
一名 30 岁女性和一名 44 岁男性分别在接受度普利尤单抗治疗 3 个月和 9 个月后出现单侧严重的角膜溃疡和穿孔。
除了在增菌培养中发现少量金黄色葡萄球菌生长外，两例患者的角膜培养均为阴性。尽管进行了强化局部抗生素治疗，但两例患者均进展为穿孔。第一例患者在角膜胶和多层羊膜移植失败后，需要进行板层角膜移植以恢复眼球完整性，而第二例患者则通过氰基丙烯酸酯胶贴成功治疗。
尽管之前有报道称度普利尤单抗治疗后会出现结膜注射和干眼症，但这是首次报告 2 例特应性皮炎患者在接受度普利尤单抗治疗后发生快速进展性角膜溃疡和穿孔的病例。这些病例发生溃疡性角膜炎的潜在病理生理学机制尚不清楚，但毫无疑问，停止度普利尤单抗治疗可防止溃疡进一步进展。在使用度普利尤单抗期间出现严重眼部症状时，需要及时与皮肤科团队讨论，可能需要更换治疗方案以阻止角膜炎的进一步进展。
