ABSTRACT
RESUMEN Mujer de 31 años con cuadro de poliartralgias, poliartritis asimétrica, fiebre, lesiones vasculíticas en piel, asociado a disminución de agudeza visual en ojo derecho, el cual presentaba compromiso corneal con adelgazamiento periférico severo, queratitis ulcerativa periférica, hipopión de fibrina y sinequias posteriores. Ante el cuadro clínico y paraclínicos con C-ANCA positivos, se realiza el diagnóstico de granulomatosis con poliangeítis con compromiso ocular (adelgazamiento corneal, queratitis ulcerativa periférica, uveítis) y sistémico. Se inicia tratamiento con metilprednisolona y ciclofosfamida con poco control, por lo que se inicia rituximab sistémico, evolucionando hacia la mejoría.
ABSTRACT A 31-year-old female, presented with polyarthralgia, asymmetrical polyarthritis, fever, vasculitis skin lesions, together with decreased visual acuity in the right eye with severe peripheral corneal melting, peripheral ulcerative keratitis, fibrin hypopyon and posterior synechiae. Given the clinical and paraclinical findings with positive C-ANCA (anti-neutrophil cytoplasmic antibodies), the patient was diagnosed with granulomatosis with polyangiitis with ocular (corneal melting, peripheral ulcerative keratitis and uveitis), and systemic involvement. Treatment was started with methylprednisolone and cyclophosphamide, but due to poor control, Rituximab was subsequently administered, with medical improvement.
Subject(s)
Humans , Female , Adult , Uveitis , Granulomatosis with Polyangiitis , RituximabABSTRACT
Objetivo: reportar un caso de perforación corneana manejado con injerto-parche de esclera. Diseño: reporte de caso. Discusión: las perforaciones corneanas requieren tratamiento quirúrgico urgente para reducir las complicaciones. Contamos con varias opciones de acuerdo al tamaño de la perforación incluyendo adhesivo tisular, transplante de membrana amniótica y queratoplastia penetrante. El injerto-parche de esclera es otra alternativa útil para el tratamiento de esta condición. Conclusiones: describimos el caso de una perforación corneana secundaria a queratitis ulcerativa periférica (QPU) asociada a Síndrome de Sjögren que fue manejada con un aloinjerto de esclera.
Objective: to report a case in which scleral patch graft was used to treat a corneal perforation. Design: case report. Discussion: corneal perforations require urgent management to reduce subsequent ocular morbidity. Depending on its size and location, treatment options include corneal gluing, amniotic membrane transplantation and corneal transplantation. Scleral patch grafting is another feasible alternative for treating this condition.Conclusions: We described a case of scleral allograft use in the management of corneal perforation due to peripheral ulcerative keratitis associated with Sjögren's syndrome.
Subject(s)
Corneal Diseases/therapy , Scleral Diseases/therapy , Corneal Ulcer/therapy , Eye Diseases/therapyABSTRACT
PURPOSE: To report a case of peripheral ulcerative keratitis in a case of primary herpes simplex infection. CASE SUMMARY: A 7-year-old male complaining of pain, redness, and decreased vision in the left eye 5 days in duration visited our clinic. The patient had also vesicular lesions over the edematous left upper eyelid. Slit-lamp examination revealed peripheral ulcerative keratitis with stromal infiltration involving the superior peripheral cornea. Corneal sensation in the left eye was decreased. The patient was advised to use topical and oral antiviral agents and a topical steroid. After 5 days of follow-up, the corneal lesions were decreased and vesicles were absent. Six months later, only minor opacities remained in the cornea. CONCLUSIONS: We report the first case report in Korea of peripheral ulcerative keratitis with blepharoconjunctivitis presented as primary herpes simplex infection which responded to antiviral and steroid treatment in a young male.
Subject(s)
Child , Humans , Male , Antiviral Agents , Cornea , Corneal Ulcer , Eyelids , Follow-Up Studies , Herpes Simplex , Korea , SensationABSTRACT
PURPOSE: To report a case of peripheral ulcerative keratitis and scleritis in a patient with pustular psoriasis. CASE SUMMARY: A 62-year-old male presented with skin lesions on the hands and feet and pain in the right eye, which started a few days prior. Corrected visual acuity was 0.5 in the right eye and 0.7 in the left eye at initial visit. Corneal edema, erosion, ulcer and peripheral corneal infiltration of the right eye were observed. However, anterior chamber reaction was not observed. Histological analysis of hand skin lesions indicated pustular psoriasis. The patient was initially treated with topical antibiotics and a combined therapy of oral and topical steroids for ocular symptoms. As a result, the right eye showed slight improvement and the oral steroid was discontinued. One month after the initial visit, scleritis appeared on the left eye and topical and oral steroids were restarted for both eyes. Two months after the initial visit, ocular symptoms were improved significantly and corrected visual acuity was 1.0 in both eyes. The mild peripheral corneal opacity remained in the right eye, but the previous inflammations in both eyes were improved. CONCLUSIONS: As shown in this case, possibility of peripheral corneal infiltration, corneal ulcer and scleritis should be considered in patients with pustular psoriasis and topical and systemic steroids should be administered if accompanying ocular manifestations occur.
Subject(s)
Humans , Male , Middle Aged , Anterior Chamber , Anti-Bacterial Agents , Corneal Edema , Corneal Opacity , Corneal Ulcer , Foot , Hand , Inflammation , Psoriasis , Scleritis , Skin , Steroids , Ulcer , Visual AcuityABSTRACT
PURPOSE: To report a case of bilateral peripheral ulcerative keratitis after cataract extraction with a clear corneal incision in a patient with rheumatoid arthritis. CASE SUMMARY: A 67-year-old woman was referred to our clinic with bilateral ocular pain and visual disturbances, 10 days after a cataract extraction in her right eye. The patient had undergone a cataract extraction with clear corneal incision in the left eye and the same procedure was performed in the right eye after 1 week. During the surgery, hyphema occurred because of the iris damage by the phacoemulsification tip. Slit lamp examination showed bilateral peripheral ulcerative keratitis around the incision site and diffused corneal edema. Topical instillation and systemic administration of antibiotic agents were given as treatment but the patient showed no improvement. Corneal culture and smear were performed and showed a negative result. Because the patient was previously diagnosed with rheumatoid arthritis and showed the characteristic finger deformity, she was diagnosed with a sterile peripheral ulcerative keratitis and was treated with oral steroid, sulfasalazine, and steroid eye drop. After 1 month of treatment, epithelial thinning of the cornea and peripheral corneal ulcer stopped progressing and showed corneal re-epithelization. CONCLUSIONS: Because peripheral ulcerative keratitis after cataract extraction with clear corneal incision can occur in a patient with rheumatoid arthritis, caution is necessary to minimize damage by careful manipulation during the operation and requires special attention in preoperative and postoperative management.
Subject(s)
Female , Humans , Arthritis, Rheumatoid , Cataract , Cataract Extraction , Congenital Abnormalities , Cornea , Corneal Edema , Corneal Ulcer , Eye , Fingers , Hyphema , Iris , Phacoemulsification , Sulfasalazine , UlcerABSTRACT
Objective@#To present a case of peripheral ulcerative keratitis (PUK) in a patient with Sweet syndrome (acute febrile neutrophilic dermatosis) and discuss its etiopathogenesis, clinical presentation, course, and management.@*Method@#This is a case report.@*Results@#A 31-year-old male, diagnosed with Sweet syndrome, was referred for redness, photophobia, and severe, deep, boring pain in the right eye. Visual acuity was 20/20 bilaterally. Inferior sectoral conjunctival and scleral hyperemia were present in the right eye. Initial treatment included topical and oral nonsteroidal antiinflammatory drugs (NSAIDs), a topical immunosuppressive agent, and an antibiotic. One month after treatment, the pain decreased but patient developed peripheral corneal thinning that gradually spread circumferentially and centrally in the right eye. Vision decreased to 20/400. A similar inferior sectoral injection was noted in the left eye. Oral prednisone was started, followed by oral immunosuppressive agent. Resolution of the PUK was noted after 1 month of immunosuppressive treatment with improvement of the vision.@*Conclusion@#PUK is a potentially blinding disorder that can be seen in Sweet syndrome. With proper knowledge of the underlying disease, close monitoring and management, PUK can be treated and cured.
Subject(s)
Sweet Syndrome , ConjunctivitisABSTRACT
Objetivo. Informar las manifestaciones oftalmológicas en pacientes con granulomatosis de Wegener (GW). Método. Se revisó la base de datos del Instituto de Oftalmología Conde de Valenciana. Se recolectó la exploración oftalmológica completa, los exámenes de laboratorio y de gabinete, el tratamiento y la evolución. Resultados. Se incluyeron 11 pacientes con GW (18 ojos). Siete pacientes masculinos y 4 femeninos con edad promedio de 43.7 años (28-55). Tres habían tenido diagnóstico previo de GW y los 8 restantes se diagnosticaron en nuestro departamento. Siete presentaron cuadros bilaterales y 4 unilaterales. Las formas de presentación clínica fueron escleritis necrosante con queratitis ulcerativa periférica (QUP) (7/18), escleritis difusa (3/18), escleritis nodular (1/18), uveítis anterior no granulomatosa (1/18), neuropatía óptica isquémica (1/18), neuropatía óptica retrobulbar (1/18), desprendimiento de retina seroso (2/18) y dacriocistitis (2/18). De los 18 ojos, la capacidad visual final fue mejor o igual a 20/40 en 13, 20/400 en 3, cuenta dedos a 30cm o no-percepción de luz en 1. Actualmente 7 pacientes se encuentran en fase inactiva. Conclusiones. Las manifestaciones oftalmológicas más frecuentes en pacientes con GW fueron: escleritis necrosante y QUP. En la mayoría, la GW se diagnosticó después de las manifestaciones oftalmológicas, sin embargo, todos presentaron síntomas sistémicos u oftalmológicos previos.
OBJECTIVE: Report the ophthalmologic manifestations among patients with Wegener 's Granulomatosis (WG). METHOD: We reviewed the database of the Instituto de Oftalmologia Fundación Conde de Valenciana in order to collect information regarding complete ophthalmic examination, laboratory and cabinet tests, treatment, and disease progression. RESULTS: We included 11 patients with WG (18 eyes). Seven men and four women, mean age 43.7 years (range = 28-55). Three patients had a prior diagnosis of WG and the remaining eight patients were diagnosed by our study team. Seven subjects developed a bilateral affection and four had unilateral involvement. The clinical presentation was necrotizing scleritis with peripheral ulcerative keratitis (PUK) (7/18), diffuse scleritis (3/18), nodular scleritis (1/18), non-granulomatous uveitis (1/18), optic ischemic neuropathy (1/18), retrobulbar neuritis (1/18), serous retinal detachment (2/18), and dacryocystitis (2/18). Final visual acuity was better or equal to 20/40 (13/18), 20/400 (3/18), finger-counting or no-perception of light in 1/18. Currently, seven patients are symptom free. CONCLUSIONS: The most frequent ophthalmic manifestations among our patients with WG were: necrotizing scleritis and PUK. In most cases, WG was diagnosed after ophthalmic manifestations; however, all patients displayed prior systemic or ocular symptoms.