Clinical Outcomes in Patients with Peripheral Ulcerative Keratitis at a Tertiary Academic Center

Abstract

Purpose : Peripheral ulcerative keratitis (PUK) consists of a group of corneal inflammatory disorders resulting in peripheral corneal thinning and possibly corneal perforation. We evaluated the clinical course of patients with PUK to determine risk factors for perforation.

Methods : Retrospective study of 66 consecutive PUK patients (132 eyes) seen in the Division of Ocular Immunology 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. Caucasians comprised 48% of patients. 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. Of the 132 eyes examined at baseline, 55 (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 from presentation. Surgical management for these 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.

Conclusions : 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 useful to reduce the risk of perforation, especially in those with an underlying autoimmune disorder.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.