scholarly journals Peripheral Ulcerative Keratitis in a Patient with Bilateral Scleritis: Medical and Surgical Management

2020 ◽  
Vol 11 (3) ◽  
pp. 500-506
Author(s):  
June Artaechevarria Artieda ◽  
Nuria Estébanez-Corrales ◽  
Olga Sánchez-Pernaute ◽  
Nicolás Alejandre-Alba
Keyword(s):  
Oral Prednisone ◽  
Previous History ◽  
Surgical Techniques ◽  
Lamellar Keratoplasty ◽  
Systemic Autoimmune Disease ◽  
Negative Results ◽  
Peripheral Ulcerative Keratitis ◽  
Anterior Lamellar Keratoplasty ◽  
Ulcerative Keratitis ◽  
Corneal Thinning

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.

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
Keyword(s):  
Hiv Infection ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Health Clinic ◽  
Corneal Perforation ◽  
Excellent Outcome ◽  
Peripheral Ulcerative Keratitis ◽  
Anterior Lamellar Keratoplasty ◽  
Ulcerative Keratitis ◽  
Primary Presentation

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.

Corneal graft surgery: A monocentric long-term analysis

2020 ◽  
pp. 112067212094759
Author(s):  
Andrea Montesel ◽  
Jorge L Alió del Barrio ◽  
Pilar Yébana Rubio ◽  
Jorge L Alió
Keyword(s):  
Survival Rates ◽  
Surgical Techniques ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corneal Transplant ◽  
Inclusion Criteria ◽  
Visual Outcomes ◽  
Anterior Lamellar Keratoplasty ◽  
Immunological Rejection ◽  
Clinical Records

Purpose: To investigate indications, outcomes and changes in clinical patterns of keratoplasty surgery in a Spanish tertiary eye center. Setting: Vissum Instituto Oftalmológico, Alicante, Spain. Methods: A retrospective review was performed on clinical records of patients that underwent any kind of corneal transplant from 2001 to 2017 in the study center. Inclusion criteria involved the presence of detailed preoperative examination, surgical report and at least 12 months follow-up after the surgery. A statistical analysis was performed on the indications for keratoplasty, survival rates, type of graft failures, and visual outcomes. Results: A total of 907 keratoplasties procedures were identified. About 432 penetrating keratoplasty (PK), 148 deep anterior lamellar keratoplasty (DALK), and 134 endothelial keratoplasty (EK) met the inclusion criteria. Cumulative survival rate ranged from 94% to 69% in a 1-year period and from 85% to 45% in a 5-years period according to the different graft types. The main cause for failure was immunological rejection for PK, surface diseases for DALK and primary graft failure for EK. Postoperative visual function improved for all the surgical techniques. Conclusion: Corneal transplant is a challenging surgery still complicated by a relevant risk of failure. Our study offers a useful opinion of the current trends on keratoplasty in our country, where the outcomes of the grafts differ considerably in relation to the indications and the different surgical techniques, with lamellar procedures that showed higher rates of success and better visual outcomes than full-thickness grafts.

Toward Safer Treatment Options for Advanced Keratoconus

2015 ◽  
Vol 8 (1) ◽  
pp. 33
Author(s):  
Jack Parker ◽  
Ricarda M Konder ◽  
Korine van Dijk ◽  
Gerrit RJ Melles ◽  
◽  
...  
Keyword(s):  
Penetrating Keratoplasty ◽  
Treatment Options ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Visual Rehabilitation ◽  
Corneal Disease ◽  
Anterior Lamellar Keratoplasty ◽  
New Treatment ◽  
Irregular Astigmatism ◽  
Corneal Thinning

Keratoconus is a bilateral and progressive corneal disease characterized by a significant increase in irregular astigmatism and corneal thinning. Numerous treatments—including penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), ultraviolet-crosslinking (UV-CXL), and intracorneal ring segments—are available for halting progression and/or obtaining (partial) visual rehabilitation. Recently, midstromal Bowman layer transplantation has been introduced as a new treatment option for advanced keratoconus. This technique has shown significant promise in halting disease progression and postponing riskier procedures such as PK or DALK.

scholarly journals Recurrent Keratoconus

2013 ◽  
Vol 2 (2) ◽  
pp. 65-68
Keyword(s):  
Penetrating Keratoplasty ◽  
Treatment Options ◽  
Corneal Transplantation ◽  
Wound Dehiscence ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Time To Recurrence ◽  
Anterior Lamellar Keratoplasty ◽  
Corneal Thinning ◽  
Corneal Disorder

Abstract Keratoconus is an ectatic corneal disorder characterized by progressive corneal thinning and protrusion. Keratoconus recurrence after corneal transplantation although rare is present and has been confirmed histologically. Host, donor, genetic, mechanical and environmental factors have been proposed as predisposing factors to initiate keratoconus recurrence. The time-to-recurrence post-deep anterior lamellar keratoplasty seems to occur earlier than after penetrating keratoplasty. Wound dehiscence and high astigmatism post-transplant are plausible differential diagnosis for this entity. The treatment options are similar to primary keratoconus. Since, the era of collagen corneal cross-linking, early diagnosis is desirable as it could halt the progression of recurrent keratoconus. How to cite this article Barbara R, Barbara A. Recurrent Keratoconus. Int J Kerat Ect Cor Dis 2013;2(2):65-68.

scholarly journals The Horse Gallops But So Does the Zebra! A Case Report: Peripheral Ulcerative Keratitis

2020 ◽  
Author(s):  
sarah belghmaidi ◽  
soumia belgadi ◽  
ibtissam Hajji ◽  
abdeljalil Moutaouakil
Keyword(s):  
Case Report ◽  
Corneal Ulcer ◽  
Tear Film ◽  
Skin Lesions ◽  
Collaborative Management ◽  
Test Results ◽  
Schirmer Test ◽  
Peripheral Ulcerative Keratitis ◽  
Ulcerative Keratitis ◽  
Corneal Thinning

Abstract Introduction: Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinningCase report: A 43-year-old woman presented with bilateral tearing and ocular pain persisting for 7 months. Visual acuity was 6/6 in both eyes. On biomicroscopic examination, presence of crescent shaped corneal ulcer with perilesional haziness. A tear film study demonstrated decreased Schirmer test results (5mm in both eyes) and tear film break-up time (5 sec in both eyes). The interrogation and the patient revealed he had recurrent skin lesions in both legs with chronic itching, and recurrent oral and genital ulcers healing spontaneously. The diagnosis of behcet disease was proposed.Conclusion: Collaborative management of ophthalmic patients having systemic illness along with internists improves overall outcomes and prevents morbidity in such patients.

scholarly journals Deep Anterior Lamellar Keratoplasty for Ectatic Disease

2013 ◽  
Vol 2 (1) ◽  
pp. 20-27
Author(s):  
Isaac Ramos ◽  
Paulo Schor ◽  
Allan Luz ◽  
Luciene Babosa ◽  
Bruno Machado Fontes
Keyword(s):  
Survival Rate ◽  
Penetrating Keratoplasty ◽  
Surgical Techniques ◽  
Cost Benefit ◽  
Viable Alternative ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Cause Of Failure ◽  
Visual Results

ABSTRACT Recently, deep anterior lamellar keratoplasty (DALK) has received attention for patients with ectatic diseases not affecting the endothelium. However, it was not always so. For years, DALK was overlooked due to the difficulty in achieving good visual results, which were considered weak in comparison with the results of penetrating keratoplasty (PK). DALK was proposed to retain a patient's healthy endothelium; thereby avoiding some possible complications of PK. Preservation of the endothelium contributes to prolonged survival of the button and thus overcomes a major cause of failure after PK. DALK is now accepted as a viable alternative to PK. With advances in surgical techniques, instruments, and imaging technologies, visual results obtained with lamellar keratoplasty are equivalent to visual outcomes with PK, in addition to providing a transplant cost benefit owing to a better transplantation survival rate. How to cite this article Luz A, Babosa L, Fontes BM, Ramos I, Schor P, Ambrósio R Jr. Deep Anterior Lamellar Keratoplasty for Ectatic Disease. Int J Kerat Ect Cor Dis 2013;2(1):20-27.

scholarly journals Corneal transplantation for keratoconus

2013 ◽  
Vol 6 (1) ◽  
pp. 1-8
Author(s):  
Sven Jonuscheit ◽  
Michael J Doughty
Keyword(s):  
Corneal Transplantation ◽  
Surgical Techniques ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Corneal Transplant ◽  
Eye Care ◽  
Primary Eye Care ◽  
Transplant Centre ◽  
Anterior Lamellar Keratoplasty

This review discusses current techniques of corneal transplantation for moderate to advanced keratoconus. The aim of this article is to provide primary eye care practitioners with an overview of two current corneal transplantation modalities, namely penetrating and deep anterior lamellar keratoplasty. The main surgical techniques, the outcome of the procedures, common complications and the prognosis will be reviewed. Results from ongoing studies at a corneal transplant centre in Glasgow, Scotland will be discussed. 

scholarly journals Using Anterior Segment Optical Coherence Tomography to Monitor Disease Progression in Peripheral Ulcerative Keratitis

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Aakriti Garg ◽  
Joaquin De Rojas ◽  
Priya Mathews ◽  
Albert Hazan ◽  
James Lin ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Multidisciplinary Approach ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Optical Coherence ◽  
Careful Monitoring ◽  
Laboratory Findings ◽  
Peripheral Ulcerative Keratitis ◽  
Ulcerative Keratitis ◽  
Corneal Thinning

We report two cases of peripheral ulcerative keratitis (PUK) imaged with anterior segment optical coherence tomography (AS-OCT). The first patient had prolonged nonsteroidal anti-inflammatory drug use, while the second had inflammatory arthritis by laboratory findings without any systemic findings as well as possible concurrent tuberculosis. In both patients, AS-OCT demonstrated corneal thinning at the onset of the disease with improvement six months after initiation of intensive medical therapy. Our cases highlight the need for a multidisciplinary approach and careful monitoring in PUK cases, especially with objective measures such as corneal thickness assessed with AS-OCT.

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