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Ore-oluwa Catherine Erikitola, Lona Jawaheer, Kanna Ramaesh, Deepa Anijeet; Conjunctival resection for peripheral ulcerative keratitis (PUK). Invest. Ophthalmol. Vis. Sci. 2016;57(12):1261.
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© ARVO (1962-2015); The Authors (2016-present)
Conjunctival resection as management strategy for PUK, though described 40 years ago, is relatively underutilized. Conjunctiva adjacent to PUK has been shown to be populated by inflammatory cells and cytokines. We describe a case series where conjunctival resection was used early on in the course of the disease, as a minimally invasive adjuvant treatment.
This is a retrospective review of 3 eyes of 3 patients with PUK who had conjunctival resection. Aetiology, clinical presentation, treatment, clinical course and stability after conjunctival resection were analysed.
Mean age of two male and one female patient was 68.7 years (range: 60-76 years). All patients had unilateral disease. Aetiologies included one case each of chronic recurrent blepharokeratitis (case 1), rheumatoid arthritis (case 2) and ANCA positive connective tissue disease (case 3). Extent of ulceration was 2 clock hours in case 1 and 6 clock hours in cases 2 and 3. Depth of thinning was 30 % in case 1 and 80% in cases 2 and 3. Cases 2 and 3 with connective tissue disease had systemic prednisolone in a dose of 50- 60 mg for less than 2 weeks. All patients had topical steroids (dexamethasone 0.1%) up to a frequency of 6 times a day for less than 2 weeks. All patients also received 2 hourly topical lubricants, as well as anti-metalloproteinase (tetracycline). Patients underwent excision and recession of adjacent limbal conjunctiva (limbal conjunctivectomy) as conservative measures failed to make any significant improvement in clinical course. Conservative measures were continued post operatively (tapering systemic and topical steroids, continuing topical lubricants and tetracycline derivative) in all 3 patients. Ulcerative component healed within 2 weeks. In each case, surgical treatment was successful in faster healing and tapering of systemic steroids. No recurrences were reported at 4-12month follow up.
Conjunctival resection can be an effective and simple adjuvant therapeutic modality in the treatment of PUK. Removing adjacent para-limbal source of immune trigger can aid in the quicker resolution of PUK, with reduced requirement for systemic immunosuppression with its harmful side effects. Larger comparative case studies will be needed to confirm this small scale clinical observation.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure 1: Case 2: a) Before and b)16 days after conjunctival resection
Figure 2: a) Before and b) 5 days after conjunctival resection
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