ABSTRACT
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.
ABSTRACT
PURPOSE: To assess the accuracy of estimating intraocular pressure (IOP) at the end of cataract surgery and to suggest a method of verifying this value. SETTING: University hospital in a suburban area. METHODS: Sixty-nine eyes having phacoemulsification cataract surgery without complications were studied. In stage 1, the surgeon estimated IOP using digital pressure at the end of cataract surgery while a second investigator checked the actual IOP using a handheld tonometer. The estimated and true values were compared. In a second group of patients, the IOP was measured at the end of surgery in 30 eyes using a specifically designed tonometer, the Ocular Kasaby Barraquer 20/30 (OKBT-20/30) (Ocular Instruments, Inc.). The true values were then measured using the handheld tonometer to verify the accuracy of the OKBT-20/30. RESULTS: In stage 1, 37.7% of the estimates were outside the "acceptable" IOP range of 10 mm Hg or higher to 30 mm Hg or lower. Accuracy of estimates decreased toward the extremes of IOP. This suggests that eyes with IOP values outside the acceptable range are likely to be left as such at the end of surgery. In stage 2, when the IOP was measured with the new instrument and rechecked with the electronic tonometer, 93.3% of eyes had an IOP within the reference range of 20 to 30 mm Hg; 62.3% of eyes had an IOP within this range when estimated. CONCLUSIONS: Because the digital estimate can be misleading, the OKBT-20/30 tonometer or a similar device should be used routinely to ensure each eye is left with a desirable IOP at the end of cataract surgery.
