Department of Ophthalmology (Y.L., C.M.), Princess Alexandra Hospital, Brisbane, Australia ; Department of Ophthalmology (J.M.), University of Auckland, Auckland, New Zealand ; and Faculty of Medicine (Y.L., C.M.), University of Queensland, Brisbane, Australia .
Eye Contact Lens. 2022 Jul 1;48(7):283-288. doi: 10.1097/ICL.0000000000000906. Epub 2022 May 17.
Peripheral ulcerative keratitis (PUK) can cause significant ocular morbidity and mortality. This study aimed to review the effects of systemic immunosuppression on visual outcomes.
A state-wide, retrospective case series based in Queensland, Australia, was performed. A review of patients who presented with PUK to the major tertiary ophthalmology referral centers between January 2015 and January 2021 was undertaken. Parameters recorded included clinical features at presentation, investigations undertaken, treatment provided, visual outcomes, and mortality outcomes. The effect of immunomodulatory therapy on the change in vision from presentation to the most recent review was analyzed.
Twenty-two eyes of 26 patients with PUK (average age 69.81±14.54 years) were included and had a mean follow-up period of 577.73 days. Twelve patients (54.5%) had systemic autoimmune disease, one patient (4.5%) had positive syphilis serology, and nine patients (40.9%) had idiopathic PUK. Eighteen patients (81.8%) were treated with systemic steroids and 10 patients (45.5%) were treated with steroid-sparing immunomodulatory therapy. Average logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) at presentation and final follow-up were 0.63±0.65 and 0.64±0.82, respectively. Those who were treated with immunomodulatory therapy had a nonstatistically significant improvement in BCVA (-0.10±0.29 with vs. +0.10±0.35 without), and a similar trend was seen for doxycycline (-0.08±0.09 with vs. +0.22±0.49 without). Four of five perforations (80%) were surgically managed. Four patients (18.2%) were deceased.
Peripheral ulcerative keratitis poses significant clinical challenges and requires intensive medical treatment, frequently involving systemic immunomodulatory therapy. Surgical treatment is required in a significant minority of cases. Ocular management alongside the use of doxycycline and immunomodulatory therapy in consultation with specialist physicians can optimize visual and systemic outcomes.
周围溃疡性角膜炎（PUK）可导致严重的眼部发病率和死亡率。本研究旨在综述全身免疫抑制对视力结果的影响。
在澳大利亚昆士兰州进行了一项基于全州的回顾性病例系列研究。对 2015 年 1 月至 2021 年 1 月期间在主要三级眼科转诊中心就诊的 PUK 患者进行了回顾。记录的参数包括就诊时的临床特征、进行的检查、提供的治疗、视力结果和死亡率结果。分析了免疫调节治疗对视从就诊到最近一次复查的变化的影响。
纳入了 26 例 PUK 患者的 22 只眼（平均年龄 69.81±14.54 岁），平均随访时间为 577.73 天。12 例患者（54.5%）患有系统性自身免疫性疾病，1 例患者（4.5%）梅毒血清学阳性，9 例患者（40.9%）患有特发性 PUK。18 例患者（81.8%）接受了全身皮质类固醇治疗，10 例患者（45.5%）接受了皮质类固醇免疫抑制治疗。就诊时和最终随访时平均最小角分辨率对数最佳矫正视力（BCVA）分别为 0.63±0.65 和 0.64±0.82。接受免疫调节治疗的患者 BCVA 有非统计学意义的改善（-0.10±0.29 与-0.10±0.35），强力霉素也有类似趋势（-0.08±0.09 与-0.22±0.49）。5 例穿孔中的 4 例（80%）进行了手术治疗。4 例患者（18.2%）死亡。
周围溃疡性角膜炎带来了重大的临床挑战，需要强化医疗治疗，经常涉及全身免疫调节治疗。在很大一部分病例中需要手术治疗。与专科医生协商，在使用强力霉素和免疫调节治疗的同时进行眼部治疗，可以优化视力和全身结果。
