scholarly journals Peripheral ulcerative keratitis with corneal melt as the primary presentation in a case of human immunodeficiency virus

2019 ◽  
Vol 12 (2) ◽  
pp. e226936
Author(s):  
Shokufeh Tavassoli ◽  
David Gunn ◽  
Derek Tole ◽  
Kieren Darcy

Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It is thought to be the result of immune complex deposition at the limbus, resulting in corneal inflammation and stromal melt. We present a case of a 43-year-old female patient of African origin, presenting with PUK and associated corneal perforation as the primary presentation of HIV infection. An urgent tectonic deep anterior lamellar keratoplasty was performed under general anaesthesia with excellent outcome. The patient was referred to the sexual health clinic and anti-retroviral treatment was initiated. This case is to the best of our knowledge the first report from the UK of PUK with corneal perforation as the primary presentation of HIV infection. As highlighted in this report, infection with HIV may initially be silent; therefore, it is vital to consider HIV infection when dealing with PUK of unknown aetiology.

2019 ◽  
Vol 98 (4) ◽  
Author(s):  
Rénuka S. Birbal ◽  
Jack S. Parker ◽  
Korine Dijk ◽  
Silke Oellerich ◽  
Isabel Dapena ◽  
...  

2020 ◽  
Vol 11 (3) ◽  
pp. 500-506
Author(s):  
June Artaechevarria Artieda ◽  
Nuria Estébanez-Corrales ◽  
Olga Sánchez-Pernaute ◽  
Nicolás Alejandre-Alba

Peripheral ulcerative keratitis (PUK) is a group of corneal disorders that cause peripheral corneal thinning, threatening globe integrity in advance stages. It is usually associated with systemic autoimmune diseases and management is based on local and systemic approaches. We present the case of a 47-year-old man with a previous history of bacterial keratitis in his left eye presenting with 1 month of bilateral ocular pain and redness. At examination, diffuse bilateral globe inflammation with paracentral corneal thinning in his left eye was observed. He was diagnosed with bilateral scleritis and PUK in his left eye. Workup for associated systemic autoimmune disease yielded negative results. The patient was started on pulses of intravenous methylprednisolone followed by oral prednisone failing to achieve sufficient control of the inflammatory syndrome. Subsequently, periodic intravenous cyclophosphamide was administered with a favorable response. A multilayer amniotic membrane graft was applied, but there was rapid melting with reabsorption of the tissue, resulting in extreme corneal thinning at the inferior paracentral cornea. A decentered 8.5-mm superficial anterior lamellar keratoplasty (SALK) was then performed obtaining the donor graft with a femtosecond laser but performing manual trepanation in the recipient. At 12 months, visual and biomicroscopic measures do not show deterioration and inflammation remains under control with oral azathioprine as maintenance regime. The management of PUK includes both systemic immunosuppression and tectonic procedures to preserve the globe integrity. Diverse surgical techniques have been attempted, but no definitive guidelines are available. Decentered large SALK is a simple technique that can yield acceptable visual results.


2021 ◽  
Vol Volume 15 ◽  
pp. 3549-3555
Author(s):  
Hong The Nguyen ◽  
Ngoc Dong Pham ◽  
Tung Quoc Mai ◽  
Hang Thi Thuy Do ◽  
Thi Nga Duong Nguyen ◽  
...  

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