A stitch in time saves my (ne) (vision)

Area of Science:

• Ophthalmology
• Rheumatology

Background:

• Corneal melt with iris prolapse is a rare but severe complication associated with autoimmune diseases, particularly rheumatoid arthritis.
• Peripheral ulcerative keratitis (PUK) can lead to corneal melt and vision loss, especially in patients with underlying systemic inflammatory conditions.

Observation:

• A 56-year-old male with rheumatoid arthritis and type 2 diabetes presented with corneal melt and iris prolapse in his only functioning eye.
• The patient had a history of PUK and vision loss in the contralateral eye following keratoplasty.
• The condition progressed despite initial management, necessitating advanced surgical intervention.

Findings:

• Successful salvage of the eyeball and vision was achieved through a combination of medical management and surgical intervention, including a patch graft.
• Anterior segment optical coherence tomography (AS-OCT) was utilized for pre- and post-operative assessment.
• The case underscores the challenges in managing sight-threatening ocular complications in patients with autoimmune diseases.

Implications:

• This case highlights the importance of vigilant monitoring and aggressive management of ocular complications in patients with rheumatoid arthritis.
• The successful surgical technique provides a potential approach for similar complex cases of corneal melt and iris prolapse.
• Early intervention and multidisciplinary care are crucial for preserving vision in patients with severe PUK and autoimmune comorbidities.