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Peripheral Ulcerative Keratitis and Corneal Melt: A 10-Year Single Center Review With Historical Comparison

Knox Cartwright, Nathaniel E. MA, FRCOphth; Tole, Derek M. FRCOphth; Georgoudis, Panagiotis MRCOphth; Cook, Stuart D. PhD, FRCOphth

doi: 10.1097/ICO.0000000000000008
Clinical Science

Purpose: Management of noninfectious ulcerative keratitis (UK) and associated systemic disorders has changed over recent years. This study aimed to analyze a recent cohort of patients with UK in this context.

Methods: The case notes of all the patients attending a specialist corneal immunosuppression clinic between June 2002 and July 2012 were reviewed. A subgroup comparison of those with rheumatoid arthritis (RA) was made with those included in an earlier report from this same center (Malik et al. Eur J Ophthalmol. 2006;16:791–797). The Fisher exact test was used for statistical comparison, and a Bonferroni correction was applied.

Results: Seventy patients, whose mean age was 65.0 years (median, 64 years), were included. Fifteen (21%) had bilateral disease, and forty-six had RA (66%). At presentation, the mean (median) visual acuity (VA) was 0.59 (0.18) logarithm of the minimum angle of resolution equivalent to 6/24 (6/9) Snellen. All the patients were prescribed systemic corticosteroids, which were later stopped in 45 (64%) patients. All but 2 were treated with steroid-sparing immunosuppressive agents, with each patient being prescribed a mean of 1.5 medications (range, 0–4), including prednisolone. These included prednisolone (70, 100%), methotrexate (47, 67%), mycophenolate (15, 21%), tacrolimus (5, 7%), and azathioprine (4, 6%). No irreversible side effects occurred. After perforation, 12 eyes of 11 patients (16%) underwent a corneal transplantation, and 10 (83%) of these remained clear. The mean (median) VA of the affected eyes when last seen was 0.34 (0.18) logarithm of the minimum angle of resolution equivalent to 6/13 (6/9) Snellen. The subset of patients with RA had significantly lower rates of corneal perforation and a VA ≤ 6/60 when last seen (P < 0.05) compared with that of the earlier cohort.

Conclusions: Ocular morbidity associated with UK has fallen, possibly because of a move toward more aggressive systemic antiinflammatory therapy.

Bristol Eye Hospital, Bristol, United Kingdom.

Reprints: Nathaniel E. Knox Cartwright, Bristol Eye Hospital, Lower Maudlin St, Bristol BS1 2LX, United Kingdom (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received March 05, 2013

Accepted September 16, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.