Clinical Outcomes in Peripheral Ulcerative Keratitis

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Peripheral ulcerative keratitis (PUK) is a severe ocular condition often associated with systemic autoimmune diseases.
• Effective management strategies are crucial to prevent vision loss and globe integrity.

Purpose of the Study:

• To evaluate clinical characteristics and treatment outcomes in patients with peripheral ulcerative keratitis (PUK).
• To assess the efficacy of systemic therapies in managing PUK, including disease control and corticosteroid withdrawal.

Main Methods:

• A retrospective case series design was employed, analyzing data from 57 patients diagnosed with PUK between 2003 and 2022.
• Data included patient demographics, systemic disease associations, disease laterality, PUK activity, corneal perforation, and treatment regimens.
• Key outcomes assessed were disease control, corticosteroid-sparing and discontinuation success, sustained drug-free remission, disease reactivation, and need for surgery.

Main Results:

• All patients achieved disease control within a median of 1.3 months with systemic therapy.
• Corticosteroid-sparing and discontinuation success rates were 0.44 and 0.27 per patient-year, respectively.
• Sustained drug-free remission was achieved in only 6% of patients, with a disease reactivation rate of 0.07 per eye-year.

Conclusions:

• Systemic therapy is effective in achieving disease control and facilitating corticosteroid reduction in PUK patients.
• While initial disease control is achievable, sustained drug-free remission is infrequent, highlighting the chronic nature of the condition for many.
• Close monitoring for disease reactivation is essential even after initial control is established.