| Presentation preference | Oral presentation |
| Title | Peripheral Ulcerative Keratitis: Clinical Outcomes at a Tertiary Academic Center |
| Purpose | Peripheral ulcerative keratitis is an inflammatory condition of the peripheral cornea resulting in thinning, stromal destruction, and eventual perforation. We evaluated the clinical course of patients with PUK to determine risk factors for perforation. |
| Methods | Retrospective study of 66 PUK patients seen at the Wilmer Eye Institute from January 2003 to August 2022. Data collected included demographics, immunosuppressive medications and doses, and whether perforation occurred. |
| Results | The median age was 54 years. 55% of patients were male, and 48% were caucasian. The median duration of ocular symptoms prior to presentation was 3 months. A systemic disease was present in 39 patients (59%); the most common was rheumatoid arthritis. At baseline, 55 eyes (42%) had corneal thinning, and 8 (6%) had perforated prior to presentation. During follow-up, 5 eyes (4%) perforated in a median time of 82 days. Surgical management consisted of a patch-graft (PG) in 3 eyes and a penetrating keratoplasty (PK) in 3 eyes. Two eyes required multiple surgical interventions: one with a PG then subsequent PK, and one with 2 successive PKs. At the time of perforation 3 of 5 patients were on corticosteroids, with a median dose of 60mg daily. Only one patient was taking a systemic immunosuppressive medication (mycophenolate mofetil dosed at 1 gram daily). Of all patients who experienced perforation 58% (N=7) had an underlying systemic illness.
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| Conclusion | The percentage of patients with PUK requiring PG or PK for corneal perforation decreases with aggressive initiation of prednisone with combination immunosuppressive therapy. Long term immunosuppressive therapy may be especially useful in those with an underlying autoimmune disorder. |
| Conflict of interest | No |
Authors 1
| Last name | MALLEM |
| Initials of first name(s) | K |
| Department | Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, |
| City | Baltimore, MD |
| Country | United States |
Authors 2
| Last name | Chaon, MD |
| Initials of first name(s) | B |
| Department | Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, |
| City | Baltimore, MD |
| Country | United States |
Authors 3
| Last name | Burkholder, MD |
| Initials of first name(s) | B |
| Department | Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, |
| City | Baltimore, MD |
| Country | United States |
Authors 4
| Last name | Walsh, MD, PhD |
| Initials of first name(s) | J |
| Department | Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, |
| City | Baltimore, MD |
| Country | United States |
Authors 5
| Last name | Thorne, MD, PhD |
| Initials of first name(s) | J |
| Department | Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, |
| City | Baltimore, MD |
| Country | United States |
Authors 6
| Last name | Berkenstock, MD |
| Initials of first name(s) | M |
| Department | Division of Ocular Immunology, Wilmer Eye Institute, Johns Hopkins School of Medicine, |
| City | Baltimore, MD |
| Country | United States |
