Peripheral Ulcerative Keratitis: A Review.

Area of Science:

• Ophthalmology
• Immunology

Background:

• Peripheral ulcerative keratitis (PUK) is a rare, serious ocular condition with significant ophthalmological and systemic implications.
• It involves progressive peripheral corneal thinning and epithelial defects, often linked to inflammatory conditions or presenting as Mooren ulcer.
• Associated conditions include autoimmune diseases, infections, dermatologic disorders, and post-ocular surgery complications.

Purpose of the Study:

• To summarize the clinical presentation, pathogenesis, diagnostic approaches, and management strategies for peripheral ulcerative keratitis.
• To highlight the role of immune responses in PUK pathogenesis and the efficacy of various treatment modalities.

Main Methods:

• Literature review and synthesis of current knowledge on PUK.
• Analysis of clinical features, diagnostic criteria, and treatment outcomes.

Main Results:

• PUK pathogenesis involves cell-mediated and auto-antibody-mediated immune responses, leading to corneal tissue destruction via matrix metalloproteinases.
• Clinical presentation includes painful vision loss, peripheral corneal ulcer, and associated ocular inflammation (scleritis, iritis).
• Diagnosis requires identifying the underlying etiology and differentiating from similar conditions like marginal keratitis.

Conclusions:

• Effective management of PUK necessitates addressing the underlying cause, employing topical lubrication, antimicrobials, or anti-inflammatories as indicated.
• Biologic immunomodulatory therapies show promise for autoimmune-related PUK.
• Surgical intervention is reserved for severe cases with significant thinning or perforation.