Purpose. To report the use of
infliximab in the rapid stabilization of a case of progressive, bilateral rheumatoid peripheral
ulcerative keratitis (PUK) that failed to respond to conventional immunosuppressive therapy. Methods. A single interventional case report. Results. A patient with
rheumatoid arthritis presented with bilateral PUK following a 2-month history of ocular discomfort and redness. His systemic
prednisolone (PDN) and
methotrexate (MTX) were increased and, despite an initial favorable response, bilateral recurrent
corneal perforations ensued. Both eyes underwent
cyanoacrylate glue repair, amniotic membrane
transplantation (AMT), and
penetrating keratoplasty (PKP). Recurrence of the disease and bilateral perforations of the second PKP in both eyes prompted administration of intravenous
infliximab immediately after the fourth PKP. The disease activity rapidly settled in both eyes, and at eighteen-month followup, after 12
infliximab infusions, the PUK remains quiescent with no further graft thinning or perforation. Conclusion.
Infliximab can be used to arrest the progression of severe bilateral rheumatoid PUK in cases that are refractory to conventional treatment.