Abstract
Purpose:
To study ocular and systemic evolution of keratitis patients with autoimmune etiology according to the immunosuppressive agent used for treatment.
Methods:
Retrospective, observational and descriptive study of patients with autoimmune diseases associated with corneal manifestations between 2008-2014. Age, sex, autoimmune disease, presence or absence of systemic manifestations, visual acuity of the first and last visit, ocular manifestations in the first consultation and its evolution to the last registered, ophthalmic and systemic prescription medication, dosage and side effects associated were registered.
Results:
A total of 64 eyes of 32 patients with ages between 22 to 90 years were include; 31 female, 1% male. The most common autoimmune disease was rheumatoid arthritis and presented articular manifestations in 69% of cases. LogMAR ranged from 0 to light perception. Clinical most common presentation was superficial punctate keratitis, corneal melting, perforation, filamentary keratitis, limbal guttering, scleritis, peripheral ulcerative keratitis and corneal opacities. The immunosuppressive treatment found in 50% of the cases was prednisone followed by adalimumab, methotrexate, leflunomide and azathioprine. All patients who underwent surgery were given a bolus of 500mg of trans-surgical methylprednisolone and three days after the procedure.<br /> <br /> Patients treated with 50 mg of oral prednisone alone presented keratolysis that continued even after tectonic graft treatment, when adding azathioprine, leflunomide and adalimumab, the lytic process decreased and visual acuity remained unchanged. The result in patients with Methotrexate was dose dependent, at 7.5 and 12.5 mg weekly lysis was also experienced whereas at doses of 15 mg weekly the lytic process was stopped and visual acuity remained. The most common adverse effects of immunosuppressive drugs were from azathioprine gastritis (n=1) and with prednisolone (n=1) weight gain and ostheoporosis. In all patients in whom immunosuppressive treatment was added an important improvement in their overall systemic and dry eye symptoms was noted.
Conclusions:
Results and adverse effects are dependent on the type of immunosuppressant used. Steroid use alone is insufficient for the control of both systemic and ocular disease.