Management of Rheumatoid Arthritis-Related Peripheral Ulcerative Keratitis Using Glycerol-Preserved Corneas

This study aimed to report the surgical outcome of patch grafts using glycerol-preserved corneas in perforated or near-perforated rheumatoid arthritis-related peripheral ulcerative keratitis (PUK).

This is a retrospective chart review of a case series.

The medical records at a single institution were reviewed between July 2004 and July 2011. Of the 19 patients with PUK, 7 (36.8%) underwent glycerol-preserved cornea patch grafts for rheumatoid arthritis-related PUK. The clinical features, precipitating factors, adjuvant therapy, and therapeutic outcomes were analyzed.

The age of patients ranged from 49 to 82 years (mean [SD], 64.43 [13.53] years) for the 4 women and 3 men with perforated or near-perforated PUK who were managed with systemic and local immunosuppressive therapy. A wound culture revealed 1 Staphylococcus aureus and 1 filamentary fungal infection. The mean (SD) area of the graft was 13.28 (6.11) mm; the mean (SD) time to reepithelializaiton was 7.0 (1.60) days. One patient had high intraocular pressure managed by topical medication; another had a complicated cataract formation. One graft melting was successfully managed by topical and systemic medication.

Glycerol-preserved cornea patch grafts were successful in all patients and may be a viable option in perforated or near-perforated PUK, particularly when fresh donor corneas are neither available nor indicted.