A Case of Corneal Melt and Perforation Associated with Rheumatoid Arthritis Managed by Corneal Patch Graft
Correspondence Address :
Supriya Adinath Pokle,
Resident, Department of Ophthalmology, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune-411018, Maharashtra, India.
E-mail: supriya.pokle8@gmail.com
Corneal melt is a rare yet severe complication of Peripheral Ulcerative Keratitis (PUK), observed in patients with Rheumatoid Arthritis (RA). The mortality rate associated with corneal melt is high, warranting aggressive treatment. A 50-year-old female, a known case of RA for 20 years, presented with complaints of blurred vision, watering, irritation, and photophobia in both eyes for the last year, with worsening symptoms in the Right Eye (RE) for the past 15 days. She was diagnosed elsewhere in a private hospital with RE corneal melt and perforation and inferior corneal thinning in the Left Eye (LE), with an ulcer defect. She underwent corneal perforation suturing in the RE before reaching the present facility. On examination, a sutured corneal perforation was present in the RE, and corneal thinning and melt were seen para-centrally and inferiorly in the LE. Surgical treatment with RE corneal patch graft repair was performed. The patient was given oral methotrexate and prednisolone for aggressive systemic control of RA and to ensure the survival of the patch graft. The vision in the RE improved following the procedure, maintaining the tectonic integrity of the cornea. On follow-up, aleucomatous opacity was noted in the RE patch graft tissue. Corneal thinning in the LE was treated topically with artificial tears and antibiotic eyedrops, which eventually healed, forming macular corneal opacity. Overall, corneal patch graft repair enabled the maintenance of tectonic support and corneal integrity, as well as vision improvement in the patient with RA presenting with the complication of corneal melt and perforation.
Blurred vision, Corneal opacity, Peripheral Ulcerative Keratitis, Photophobia
DOI: 10.7860/JCDR/2024/68873.19364
Date of Submission: Dec 06, 2023
Date of Peer Review: Feb 10, 2024
Date of Acceptance: Mar 02, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 08, 2023
• Manual Googling: Feb 26, 2024
• iThenticate Software: Feb 29, 2024 (8%)
ETYMOLOGY: Author Origin
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