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Sarah Brem Sunshine, Taylor Starnes, Elmer Tu, Kai Kang, Sandeep Jain, M. Soledad Cortina, Ali R Djalilian; Corneal Melt: A devastating disease without good treatment options. Invest. Ophthalmol. Vis. Sci. 2020;61(7):2922.
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Corneal melt is a devastating complication of end stage corneal disease. There are both immune and infectious causes. Despite the advances in corneal transplantation and rehabilitation, once the process of corneal melting has begun, it is challenging to reverse andthere are few therapeutic options. Recently, there has been significant improvement in the ability to modulate the immune system systemically with an influx of immunomodulators being used clinically. We present seven patients with immune mediated melts causing perforation or severe vision loss. Through this case series, we hope to highlight the importance of studying immune related corneal melts. Additionally, we believe that these cases help provide insight into how to utilize known immunomodulators to halt the progression of this debilitating disease.
This is a retrospective study evaluating patients at the University of Illinois of Chicago who were evaluated with immune mediated corneal melts in 2019. 7 patients were included in the study based on presentation with an acute immune related corneal melt and an acute change in ocular symptoms from July 2019 through October 2019.
The patients age ranged from 53-70 (mean 60), 4/7 male. The immune related diseases included ocular GVHD, rheumatoid arthritis, sjogren’s syndrome, psoriatic arthritis, and rosacea. The patients’ presenting vision was an average 20/280 (20/30 - Hand-Motion (HM)) and the ultimate vision was 20/330 (20/25-HM) (p-value 0.8). The patients were treated with topical, oral and intravenous corticosteroid therapy, topical cyclosporine, and mycophenolate mofetil. 6 of 7 patients perforated ultimately requiring an invasive procedure; 2 of 7 required closure with cyanoacrylate glue, 1 of 7 required an amniotic membrane graft, and 5 of 7 required a penetrating keratoplasty.
In this retrospective case series, we review 7 patients with varying causes of immune related melt. These patients resulted in severe ocular complications with poor visual prognosis. This series highlights the importance of studying immune related melts as our current treatments are insufficient to improve vision in a meaningful way. We hypothesize that topical immunomodulators would be a potentially beneficial approach to treatment of these patients, and urge further studies both in animals and humans to meet this urgent clinical need.
This is a 2020 ARVO Annual Meeting abstract.
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