Clinical characteristics and risk factors of rheumatoid arthritis with ulcerative keratitis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical characteristics, risk factors and prognosis of ulcerative keratitis (UK) in patients with rheumatoid arthritis (RA).@*METHODS@#Sixteen patients with UK (the UK group) were screened among 4 773 RA patients hospitalized at Peking University People's Hospital from January 2003 to May 2021, and 72 patients with RA without UK in the control group were selected by propensity score matching (PSM). The clinical features, laboratory data and medications between the two groups were collected and analyzed.@*RESULTS@#The average age of the patients with RA was 60 years at the time of the complication of UK. UK appeared on average in the 16th year of RA, with the majority of UK occurring in the 7th year of RA and beyond (14 cases), however, a minority of UK was the first symptom of RA (1 case). UK associated with RA manifested as simple marginal UK in 8 cases, marginal UK with perforation in 5 cases, marginal UK with uveitis in 2 cases and central UK with perforation in 1 case. The number of swollen joints was significantly higher in the UK group than in the control group [6.0(2.5, 23.0) vs. 3.0(1.0, 9.8), Z=-2.047, P=0.041], and the proportion of secondary Sjögren syndrome (SS, 37.5% vs. 6.9%, χ2=11.175, P=0.004) and interstitial lung disease (ILD, 37.5% vs. 8.3%, χ2=9.456, P=0.008) were significantly higher in the RA patients with UK than the patients without UK. The uses of sulfasalazine (12.5% vs. 48.6%, χ2=7.006, P=0.008), leflunomide (31.3% vs. 63.9%, χ2=5.723, P=0.017) and gold salt(6.3% vs. 33.8%, χ2=4.841, P=0.032)were significantly lower in the UK group than in the control group. However, there was no statistically significant comparison between the two groups for the 28-joint disease activity score-erythrocyte sedimentation rate (5.3±1.8 vs. 5.1±1.6, t=0.309, P=0.761). Logistic analysis showed the number of swollen joints (OR=1.148), secondary SS (OR=79.118), complicated with ILD (OR=6.596) and the use of sulfasalazine (OR=0.037) were independent relevant factors (P < 0.05) for UK in RA patients.@*CONCLUSION@#The number of swollen joints, secondary SS, complicated with ILD and the use of sulfasalazine are independent relevant factors for UK in patients with RA.

Ayurvedic management of Ulcerative Keratitis – A case report

Ulcerative Keratitis is a sight-threatening corneal infection. It is one of the most common global causes ofirreversible blindness due to corneal diseases. This case report highlights the potential of Ayurvedicmanagement in nonresponding ulcerative keratitis. A 20 year old boy came to the outpatient departmentwith redness, discharge, photophobia and defective vision in the right eye since 4 months following aforeign body injury. He was treated at leading ophthalmic hospital for keratitis but due to poor responsewas suggested keratoplasty and the patient had opted for Ayurvedic treatment. He was initially treated inthe OPD and since he started responding well to treatment, he was admitted in the hospital. He underwent Jaloukavacharana, Snehapana, Virechana, Nasya, Anjana, Tarpana and Putapaka. He wascompletely relieved of pain, redness, discharge, photophobia. His BCVA was hand movements at the timeof the first visit and it improved to 6/24 at the time of discharge. Ayurveda has an important role to playin infective eye diseases which needs to be explored scientifically.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Uso de rituximab en queratopatía ulcerativa periférica y uveítis secundaria a granulomatosis con poliangeítis / Use of rituximab for granulomatosis with polyangiitis-associated peripheral ulcerative keratitis

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.

A Case of Peripheral Ulcerative Keratitis and Scleritis in a Patient with Pustular Psoriasis

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.

Injerto-parche de esclera en perforación corneana secundaria a queratitis periférica ulcerativa / Scleral graft patch in corneal perforation due to peripheral ulcerative keratitis

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.

A Case of Peripheral Ulcerative Keratitis as Primary Herpes Simplex Infection in a Child

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.

A Case of Bilateral Peripheral Ulcerative Keratitis in a Patient with Rheumatoid Arthritis after Cataract Extraction

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.

Uso do colírio de Citrus lemon em úlceras de córnea induzidas em coelhos / Use of Citrus lemon eyedrops in corneal ulcers induced in rabbits

Avaliaram-se e compararam-se clinicamente os efeitos de colírios de Citrus lemon (CL) na reparação de úlcera corneal superficial. Foram utilizadas 50 coelhas, distribuídas em cinco grupos experimentais de 10 animais cada. Após a indução da úlcera, três grupos foram tratados com colírios de CL, nas concentrações de 1,5% (GL1,5), 3% (GL3) e 5% (GL5). Um quarto grupo foi tratado com Tween 80 a 8%, diluente utilizado na produção dos colírios de CL, e o quinto grupo, controle, recebeu substituto da lágrima. Os grupos foram distribuídos em dois subgrupos de cinco animais; assim, o primeiro (M1) foi avaliado após 24 horas, e o segundo (M5) após cinco dias. Não houve diferença entre os tratamentos quanto aos sinais clínicos secreção, hiperemia conjuntival, quemose e opacidade corneal. A extensão da úlcera corneal diminuiu, de forma significativa, em todos os grupos no M5, com exceção do GL3, o qual apresentou menor mediana quanto à extensão no M1. O colírio de óleo essencial de Citrus lemon pode ser utilizado no tratamento de ceratites ulcerativas superficiais, sem induzir irritação conjuntival, favorecendo a reepitelização corneal.

The aim of this study was to clinically evaluate and compare the effects of Citrus lemon (CL) eye drops in the repair of superficial corneal ulcers. Fifty female rabbits were used, constituting five experimental groups with 10 animals each. After ulcer induction, three groups were treated with CL eye drops, at 1.5% (GL1, 5), 3% (GL3) and 5% (GL5) concentrations. Another group was treated with Tween 80 8% solvent used in the production of CL eye drops, and the control group received tear substitute. The experimental groups were divided into two subgroups (five animals). The first (M1) was evaluated after 24 hours and the second (M5) after five days. There was no difference between treatments for clinical signs of secretion, conjunctival hyperemia, chemosis and corneal opacity. The extension of corneal ulcer significantly decreased in all groups in M5, the exception was GL3, which had a lower median of extension in the M1. The eye drops made of Citrus lemon essential oil can be used in the treatment of superficial ulcerative keratitis, without inducing conjunctival irritation, favoring corneal reepithelialization.

Ceratomicose em equinos / Equine keratomycosis

O cavalo, dado o seu meio ambiente, está sujeito a afecções frequentes da córnea e da conjuntiva, tecidos oculares bastante expostos a bactérias e fungos, principalmente Aspergillus spp. e Fusarium spp. As ceratites ulcerativas bacterianas e fúngicas, bem como as ceratites fúngicas não ulcerativas, caracterizadas principalmente pelo abscesso estromal, são frequentes nessa espécie. Ocorrida a lesão inicial, perpetua-se um ciclo vicioso, com liberação de citocinas inflamatórias, que desencadeiam uma rápida e severa infiltração corneal por células polimorfonucleares. A córnea torna-se sujeita à destruição por enzimas proteolíticas liberadas pelos micro-organismos e por células inflamatórias, capazes de desencadear a dissolução estromal e a perfuração do bulbo ocular. O tratamento clínico para a resolução da doença corneal e o controle da uveíte reflexa deve ser agressivo e associado, muitas das vezes, à terapia cirúrgica. Este artigo discorre sobre a fisiopatologia e o tratamento da ceratomicose em equinos.

Environmental and behavioral factors make horses susceptible to corneal and conjunctival lesions, since these structures are constantly exposed to bacteria and fungi specially Aspergillus spp. and Fusarium spp. Bacterial and fungal ulcerative keratitis, as well as non-ulcerative fungal keratitis such as stromal abscess, are frequent in horses. A "cascade" effect follows the initial lesion which triggers the release of inflammatory cytokines followed by an acute and severe infiltrate of polymorphonuclear cells in the cornea. The cornea becomes susceptible to the activity of proteolytic enzymes released by microorganisms and polymorphonuclear cells, resulting in stromal degradation and ocular perforation. The medical treatment targeting the corneal disease and the controlling of reflexive uveitis should be aggressive and surgical therapy should be associated in most of the cases. This paper reviews the pathophysiology of keratomycosis in horses and specific aspects of the treatment in this species.

Peripheral ulcerative keratitis in Sweet syndrome

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.

Limbal autograft transplantation in a dog with alkali-induced ulceration / Transplante de limbo autógeno em cão com úlcera por álcali

A case of a 3-month-old female mongrel dog with a history of apathy and previous contact with an alkaline (sodium hydroxide) is reported. The dog was reluctant to open the right eye. Ophthalmic examination revealed blepharospasm, photophobia, epiphora, discrete chemosis, conjunctival hyperemia, and diffuse corneal edema involving the limbus. The fluorescein test was positive and the result of the Schirmer tear test was 32mm min-1. On the basis of these findings the diagnosis was alkali-induced ulceration and limbal autograft transplantation was performed. Corneal vascularization was observed by the third postoperative day, with intensification in vessel number and caliber on subsequent days and small areas of corneal transparency. The present results show that limbal autograft transplantation is a feasible procedure for the therapeutic management of alkali-induced corneal ulcers.

Descreve-se um caso de um animal da espécie canina, fêmea, sem raça definida, de três meses de idade, com histórico de apatia, contato prévio com produto alcalino (hidróxido de sódio) e relutância em abrir o olho direito. Ao exame oftálmico, foram observados blefarospasmo, fotofobia, epífora, quemose discreta, hiperemia conjuntival, e edema corneal difuso com comprometimento do limbo. Foram realizados o teste da fluoresceína positivo e o Teste Lacrimal de Schirmer 32mm min-1. Com base nos achados, firmou-se o diagnóstico de úlcera por álcali e realizou-se transplante autógeno do limbo. No pós-operatório, observou-se vascularização corneal a partir do terceiro dia e sua intensificação, em número e calibre, nos dias subseqüentes. Também foram observadas mínimas áreas de transparência corneal. Os resultados obtidos permitem admitir que o transplante autógeno de limbo é procedimento factível para o manejo da terapia de úlceras de córnea por álcali.

Membrana amniótica canina utilizada como bandagem em úlcera superficial de córnea de coelhos: aspectos clínicos / Canine amniotic membrane used as a bandage on rabbit superficial corneal ulceration: clinical aspects

Realizou-se a ceratectomia superficial em 28 coelhos, distribuídos em dois grupos. No grupo tratado, composto por 14 animais, utilizou-se a membrana amniótica canina como bandagem, suturada com sua face epitelial voltada contra a superfície corneana. O grupo controle não recebeu tratamento. A avaliação clínica foi realizada 24 horas após a cirurgia, a cada dois dias durante uma semana e a cada quatro dias até 180 dias. Avaliaram-se os efeitos da membrana amniótica como bandagem, comparando-se o tempo de epitelização da córnea entre os grupos e verificando o período necessário para que a córnea apresentasse transparência completa. A opacidade corneana esteve presente em todos os animais durante o período observado. O tratamento instituído resultou clinicamente em neovascularização corneana, opacidade de córnea mais intensa no período inicial de reparação, retardou o processo de epitelização e causou mais dor e desconforto que nos animais do grupo-controle.

Twenty-eight rabbits were submitted to superficial keratectomy. The treated group consisted of 14 animals received canine amniotic membrane as a bandage, sutured in a way that its epithelial surface was in contact with the corneal surface. The control group did not receive any treatment. The animals were submitted to clinical evaluations 24 hours after surgery, at each two-day interval during one week and at each four-day interval during 180 days. The amniotic membranes were evaluated as a bandage comparing the time needed for corneal epithelization in the treated and non-treated groups and determining the period necessary for the cornea to become completely transparent. The corneal opacity was present during the entire time of observation. The treated animals presented more opaque cornea in the early period of regeneration, with neovascularization and more pain and discomfort than the animals from control group, showing a delayed epithelization.

Diagnóstico de granulomatosis de Wegener en pacientes con enfermedades oculares inflamatorias / Diagnosis of Wegener's granulomatosis in patients with ocular inflamatory disease

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.

Ulcerative keratitis and keratomalacia in a dog caused by papain: a case report

Corneal ulceration with keratomalacia (corneal melting) is a serious disorder that can produce blindness. A one-year-old maleminiature Pinscher cross dog was presented with corneal edema caused by accidental exposure of the eye to papain (frompapaya tree). Ophthalmic exam revealed severe corneal edema and keratomalacia in the left eye. This report describes thesuccessful clinical management of the case with preservation of the cornea and vision.

Microbial cause in the ulcerative keratitis

Study aimed to introduce the etiology and pathogen of microbial ulcerative keratitis as well as biological features, impact of microorganism. The study also introduced the diagnosis of causative agents and treatment of diseases due to common microorganism such as Staphylococcus, Streptococcus, S. pneumonia, Moraxella, Pseudomonas aeruginosa