Management of a Corneal Perforation Due to Resistant Peripheral Ulcerative Keratitis by Repeated Tectonic Patch Grafting Combined with Conjunctival Resection
Abstract
Tectonic graft patching and conjunctival resection is one of the effective treatment modalities in especially resistant PUK patients with corneal perforation additional to topical and systemic immunosuppressive treatment. A 44-year-old female patient with a 10-year history of rheumatoid arthritis, was referred to our clinic with peripheric corneal perforation. Her visual acuity was at the level of hand movement perception in the left eye. Slit-lamp examination revealed medial PUK with corneal perforation. Tectonic patch grafting was performed. Two weeks later, because of small melting area at the inferior part of the graft with iris incarceration, an additional cornea-scleral graft transplantation was performed. Due to the immune nature of the PUK, limbal conjunctiva at the perforation site was also resected. Three months after the re-grafting, there was no recurrence. Best corrected visual acuity was 5/10 log MAR in the left eye.
Project Number
yok
References
- Sabhapandit S, Murthy SI, Sharma N, et al. Surgical Management of Peripheral Ulcerative Keratitis: Update on Surgical Techniques and Their Outcome. Clinical Ophthalmology. 2022;16. doi:10.2147/OPTH.S385782.
- Sharma N, Sinha G, Shekhar H, et al. Demographic profile, clinical features and outcome of peripheral ulcerative keratitis: a prospective study. British Journal of Ophthalmology. 2015;99:1503 LP - 1508. doi:10.1136/bjophthalmol-2014-306008.
- Deshmukh R, Stevenson LJ, Vajpayee R. Management of corneal perforations: An update. Indian J Ophthalmol. 2020;68:7-14. doi:10.4103/ijo.IJO_1151_19.
- Knop E, Knop N. The role of eye-associated lymphoid tissue in corneal immune protection. J Anat. 2005;206. doi:10.1111/j.1469-7580.2005.00394.x.
- Gomes BF, Santhiago MR. Biology of peripheral ulcerative keratitis. Exp Eye Res. 2021;204:108458. doi:10.1016/j.exer.2021.108458.
- Soong, H. Kaz M.D.; Katz, Douglas G. M.D.; Farjo, Ayad A. M.D.; Sugar, Alan M.D.; Meyer RFMD. Central Lamellar Keratoplasty for Optical Indications. Cornea. 18:249.
- Soong HK, Farjo AA, Katz D, et al. Lamellar Corneal Patch Grafts in the Management of Corneal Melting. Cornea. 2000;19:126-134.
- Vajpayee RB. Tectonic Grafts for Corneal Thinning and Perforations. Cornea. 2002;21:792-797.
- Galor A, Thorne JE. Scleritis and Peripheral Ulcerative Keratitis. Rheumatic Disease Clinics of North America. 2007;33. doi:10.1016/j.rdc.2007.08.002.
- Hassanpour K, ElSheikh RH, Arabi A, et al. Peripheral Ulcerative Keratitis: A Review. J Ophthalmic Vis Res. 2022. doi:10.18502/jovr.v17i2.10797.
Dirençli Periferik Ülseratif Keratite Bağlı Kornea Perforasyonunun Konjonktival Rezeksiyon ile Kombine Tekrarlanan Tektonik Yama Grefti ile Yönetimi
Abstract
Dirençli kornea perforasyonu olan PUK hastalarında, tektonik greft yama ve konjonktival rezeksiyon, topikal ve sistemik immünsüpresif tedaviye ek olarak, etkili tedavi yöntemlerinden biridir. On yıldır romatoid artrit öyküsü olan 44 yaşında kadın hasta periferik kornea perforasyonu ile kliniğimize sevk edildi. Görme keskinliği sol gözde el hareketlerini algılayacak düzeydeydi. Yarık lamba muayenesinde medial PUK ve korneal perforasyon saptandı. Tektonik yama grefti uygulanan hastanın iki hafta sonraki kontrolünde greftin alt kısmındaki erime alanı olması ve iris inkarseresyonu gelişmesi nedeniyle ilave kornea-skleral greft nakli yapıldı. PUK'un immun yapısı nedeniyle, perforasyon bölgesindeki limbal konjonktiva da rezeke edildi. 3 aylık takipte nüks izlenmedi. En iyi düzeltilmiş görme keskinliği sol gözde 5/10 LogMAR idi.
Supporting Institution
yok
Project Number
yok
Thanks
Prof Dr Sait Eğrilmez
References
- Sabhapandit S, Murthy SI, Sharma N, et al. Surgical Management of Peripheral Ulcerative Keratitis: Update on Surgical Techniques and Their Outcome. Clinical Ophthalmology. 2022;16. doi:10.2147/OPTH.S385782.
- Sharma N, Sinha G, Shekhar H, et al. Demographic profile, clinical features and outcome of peripheral ulcerative keratitis: a prospective study. British Journal of Ophthalmology. 2015;99:1503 LP - 1508. doi:10.1136/bjophthalmol-2014-306008.
- Deshmukh R, Stevenson LJ, Vajpayee R. Management of corneal perforations: An update. Indian J Ophthalmol. 2020;68:7-14. doi:10.4103/ijo.IJO_1151_19.
- Knop E, Knop N. The role of eye-associated lymphoid tissue in corneal immune protection. J Anat. 2005;206. doi:10.1111/j.1469-7580.2005.00394.x.
- Gomes BF, Santhiago MR. Biology of peripheral ulcerative keratitis. Exp Eye Res. 2021;204:108458. doi:10.1016/j.exer.2021.108458.
- Soong, H. Kaz M.D.; Katz, Douglas G. M.D.; Farjo, Ayad A. M.D.; Sugar, Alan M.D.; Meyer RFMD. Central Lamellar Keratoplasty for Optical Indications. Cornea. 18:249.
- Soong HK, Farjo AA, Katz D, et al. Lamellar Corneal Patch Grafts in the Management of Corneal Melting. Cornea. 2000;19:126-134.
- Vajpayee RB. Tectonic Grafts for Corneal Thinning and Perforations. Cornea. 2002;21:792-797.
- Galor A, Thorne JE. Scleritis and Peripheral Ulcerative Keratitis. Rheumatic Disease Clinics of North America. 2007;33. doi:10.1016/j.rdc.2007.08.002.
- Hassanpour K, ElSheikh RH, Arabi A, et al. Peripheral Ulcerative Keratitis: A Review. J Ophthalmic Vis Res. 2022. doi:10.18502/jovr.v17i2.10797.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case Report |
| Authors | |
| Project Number | yok |
| Submission Date | January 4, 2024 |
| Acceptance Date | July 31, 2024 |
| Publication Date | December 9, 2024 |
| DOI | https://doi.org/10.19161/etd.1263926 |
| IZ | https://izlik.org/JA54AJ47JF |
| Published in Issue | Year 2024 Volume: 63 Issue: 4 |
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