Peripheral ulcerative keratitis after trabeculectomy in a patient with rheumatoid arthritis.

Abstract

PURPOSE:

To report the unusual occurrence of peripheral ulcerative keratitis, 10 days after trabeculectomy in a 35-year-old patient with rheumatoid arthritis (RA).

METHODS:

Observational case report.

RESULTS:

A 35-year-old patient with RA and secondary Sjögren disease underwent an uneventful fornix-based trabeculectomy. Ten days after surgery, slit-lamp examination revealed a peripheral corneal ulcer extending from 5- to 7-o'clock positions with a surrounding inflammatory infiltrate and adjacent conjunctival injection. The ulcer was treated with systemic and topical steroids, antibiotic eyedrops, artificial tears, and a bandage soft contact lens. Since then, corneal re-epithelialization started and the patient's symptoms subsided. The ulcer improved steadily within 2 months while the patient used a soft contact lens. The ulcer did not reoccur in the 18 months follow-up while the patient remained under systemic treatment.

CONCLUSION:

This report highlights the importance of careful examination and close postoperative follow-up in patients with RA undergoing any intraocular surgery, to diagnose a possible development of peripheral ulcerative keratitis. Although the incidence is rare, prompt diagnosis of the peripheral ulceration is essential because if untreated it may seriously affect patient's vision.

• Authors: Dimitris Papaconstantinou, Gerasimos Georgopoulos, George Kalantzis, Augustinos Krassas, Ilias Georgalas
• Journal: Cornea (Cornea) Vol. 28 Issue 1 Pg. 111-3 (Jan 2009) ISSN: 1536-4798 [Electronic] United States
• PMID: 19092421 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Ophthalmic Solutions
• Steroids

Topics

• Adult
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Arthritis, Rheumatoid (complications)
• Contact Lenses, Hydrophilic
• Corneal Ulcer (etiology, therapy)
• Female
• Glaucoma (surgery)
• Humans
• Keratitis (etiology, therapy)
• Ophthalmic Solutions (therapeutic use)
• Postoperative Complications
• Sjogren's Syndrome (complications)
• Steroids (administration & dosage, therapeutic use)
• Time Factors
• Trabeculectomy