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Published in: International Ophthalmology 3/2018

01-06-2018 | Case Report

Corneal melting in rheumatoid arthritis patients treated with a tectonic reinforcing corneolimbal graft: an interventional case series

Authors: Eitan Livny, Michael Mimouni, Irit Bahar, Yair Molad, Assaf Gershoni, Israel Kremer

Published in: International Ophthalmology | Issue 3/2018

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Abstract

Purpose

Corneal melting with perforation is a severe ophthalmic complication of autoimmune disorders such as rheumatoid arthritis. It requires urgent medical management in order to maintain the integrity of the globe and preserve vision. Treating this complication by penetrating keratoplasty is problematic due to the high rate of recurrence of corneal melting as well as other complications. We describe the use of a tectonic fresh-tissue corneolimbal covering graft.

Methods

An interventional case series including three patients that presented to our tertiary center between 2000 and 2015 with corneal melting and perforation, secondary to rheumatoid arthritis. Emergency surgery included suturing of a 13.00- to 13.50-mm full-thickness fresh-tissue corneolimbal covering graft to the patient’s posterior limbal zone.

Results

The corneolimbal graft maintained the integrity of the cornea in all cases, by sealing the perforation and promoting the creation of a fibrovascular scar at the area of corneal melting. There were no complications, recurrences of host corneal melting, or perforation during the follow-up period.

Conclusion

Fresh-tissue full-thickness corneolimbal grafts may be used to cover emergency corneal melting and perforations secondary to rheumatoid arthritis.
Literature
2.
go back to reference Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL (2003) Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 62(8):722–727CrossRefPubMedPubMedCentral Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL (2003) Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis 62(8):722–727CrossRefPubMedPubMedCentral
3.
go back to reference Sfikakis PP (2010) The first decade of biologic TNF antagonists in clinical practice: lessons learned, unresolved issues and future directions. Curr Dir Autoimmun 11:180–210. doi:10.1159/000289205 CrossRefPubMed Sfikakis PP (2010) The first decade of biologic TNF antagonists in clinical practice: lessons learned, unresolved issues and future directions. Curr Dir Autoimmun 11:180–210. doi:10.​1159/​000289205 CrossRefPubMed
5.
6.
go back to reference Gundersen T (1958) Conjunctival flaps in the treatment of corneal disease with reference to a new technique of application. AMA Arch Ophthalmol 60(5):880–888CrossRefPubMed Gundersen T (1958) Conjunctival flaps in the treatment of corneal disease with reference to a new technique of application. AMA Arch Ophthalmol 60(5):880–888CrossRefPubMed
7.
go back to reference Soong HK, Katz DG, Farjo AA, Sugar A, Meyer RF (1999) Central lamellar keratoplasty for optical indications. Cornea 18(3):249–256CrossRefPubMed Soong HK, Katz DG, Farjo AA, Sugar A, Meyer RF (1999) Central lamellar keratoplasty for optical indications. Cornea 18(3):249–256CrossRefPubMed
8.
go back to reference Soong HK, Farjo AA, Katz D, Meyer RF, Sugar A (2000) Lamellar corneal patch grafts in the management of corneal melting. Cornea 19(2):126–134CrossRefPubMed Soong HK, Farjo AA, Katz D, Meyer RF, Sugar A (2000) Lamellar corneal patch grafts in the management of corneal melting. Cornea 19(2):126–134CrossRefPubMed
9.
go back to reference Vanathi M, Sharma N, Titiyal JS, Tandon R, Vajpayee RB (2002) Tectonic grafts for corneal thinning and perforations. Cornea 21(8):792–797CrossRefPubMed Vanathi M, Sharma N, Titiyal JS, Tandon R, Vajpayee RB (2002) Tectonic grafts for corneal thinning and perforations. Cornea 21(8):792–797CrossRefPubMed
10.
go back to reference Kremer I, Ehrenberg M, Weinberger D (2009) Fresh-tissue corneolimbal covering graft for large corneal perforation following childhood trachoma. Ophthalmic Surg Lasers Imaging 40(3):245–250CrossRefPubMed Kremer I, Ehrenberg M, Weinberger D (2009) Fresh-tissue corneolimbal covering graft for large corneal perforation following childhood trachoma. Ophthalmic Surg Lasers Imaging 40(3):245–250CrossRefPubMed
11.
go back to reference Lifshitz T, Oshry T (2001) Tectonic epikeratoplasty: a surgical procedure for corneal melting. Ophthalmic Surg Lasers 32(4):305–307PubMed Lifshitz T, Oshry T (2001) Tectonic epikeratoplasty: a surgical procedure for corneal melting. Ophthalmic Surg Lasers 32(4):305–307PubMed
12.
go back to reference Jonas JB, Rank RM, Budde WM (2001) Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or predescemetal corneal ulcers. Am J Ophthalmol 132(1):14–18CrossRefPubMed Jonas JB, Rank RM, Budde WM (2001) Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or predescemetal corneal ulcers. Am J Ophthalmol 132(1):14–18CrossRefPubMed
13.
go back to reference Ben-Sira I, Ticho U, Yassur Y (1972) Surgical treatment of active keratomalacia by “covering graft”. Isr J Med Sci 8(8):1209–1210PubMed Ben-Sira I, Ticho U, Yassur Y (1972) Surgical treatment of active keratomalacia by “covering graft”. Isr J Med Sci 8(8):1209–1210PubMed
14.
go back to reference Winter R, Pulhorn G (1978) Corneal covering of cornea in ulcerative keratitis: clinical and histological observations (author’s transl). Klin Monatsbl Augenheilkd 173(2):237–243PubMed Winter R, Pulhorn G (1978) Corneal covering of cornea in ulcerative keratitis: clinical and histological observations (author’s transl). Klin Monatsbl Augenheilkd 173(2):237–243PubMed
15.
17.
go back to reference Thomas JW, Pflugfelder SC (2005) Therapy of progressive rheumatoid arthritis-associated corneal ulceration with infliximab. Cornea 24(6):742–744CrossRefPubMed Thomas JW, Pflugfelder SC (2005) Therapy of progressive rheumatoid arthritis-associated corneal ulceration with infliximab. Cornea 24(6):742–744CrossRefPubMed
18.
go back to reference Bernauer W, Ficker LA, Watson PG, Dart JK (1995) The management of corneal perforations associated with rheumatoid arthritis. An analysis of 32 eyes. Ophthalmology 102(9):1325–1337CrossRefPubMed Bernauer W, Ficker LA, Watson PG, Dart JK (1995) The management of corneal perforations associated with rheumatoid arthritis. An analysis of 32 eyes. Ophthalmology 102(9):1325–1337CrossRefPubMed
19.
go back to reference Gokhale NS (1997) Rheumatoid corneal melting. Indian J Ophthalmol 45(4):238–239PubMed Gokhale NS (1997) Rheumatoid corneal melting. Indian J Ophthalmol 45(4):238–239PubMed
20.
go back to reference Scharf Y, Meyer E, Nahir M, Zonis S (1984) Marginal melting of cornea in rheumatoid arthritis. Ann Ophthalmol 16(10):924–926PubMed Scharf Y, Meyer E, Nahir M, Zonis S (1984) Marginal melting of cornea in rheumatoid arthritis. Ann Ophthalmol 16(10):924–926PubMed
21.
go back to reference Messmer EM, Foster CS (1995) Destructive corneal and scleral disease associated with rheumatoid arthritis. Medical and surgical management. Cornea 14(4):408–417CrossRefPubMed Messmer EM, Foster CS (1995) Destructive corneal and scleral disease associated with rheumatoid arthritis. Medical and surgical management. Cornea 14(4):408–417CrossRefPubMed
22.
go back to reference Pfister RR, Murphy GE (1980) Corneal ulceration and perforation associated with Sjogren’s syndrome. Arch Ophthalmol 98(1):89–94CrossRefPubMed Pfister RR, Murphy GE (1980) Corneal ulceration and perforation associated with Sjogren’s syndrome. Arch Ophthalmol 98(1):89–94CrossRefPubMed
23.
go back to reference Brown SI, Grayson M (1968) Marginal furrows. A characteristic corneal lesion of rheumatoid arthritis. Arch Ophthalmol 79(5):563–567CrossRefPubMed Brown SI, Grayson M (1968) Marginal furrows. A characteristic corneal lesion of rheumatoid arthritis. Arch Ophthalmol 79(5):563–567CrossRefPubMed
24.
go back to reference Pleyer U, Bertelmann E, Rieck P, Hartmann C (2002) Outcome of penetrating keratoplasty in rheumatoid arthritis. Ophthalmol J Int Ophtalmol Int J Ophthalmol Z fur Augenheilkd 216(4):249–255. doi:10.1159/000063847 CrossRef Pleyer U, Bertelmann E, Rieck P, Hartmann C (2002) Outcome of penetrating keratoplasty in rheumatoid arthritis. Ophthalmol J Int Ophtalmol Int J Ophthalmol Z fur Augenheilkd 216(4):249–255. doi:10.​1159/​000063847 CrossRef
25.
go back to reference Verhelle V, Maudgal PC (1996) Keratoplasty a chaud in severe keratitis. Bull Soc Belge Ophtalmol 261:29–36PubMed Verhelle V, Maudgal PC (1996) Keratoplasty a chaud in severe keratitis. Bull Soc Belge Ophtalmol 261:29–36PubMed
26.
go back to reference Palay DA, Stulting RD, Waring GO 3rd, Wilson LA (1992) Penetrating keratoplasty in patients with rheumatoid arthritis. Ophthalmology 99(4):622–627CrossRefPubMed Palay DA, Stulting RD, Waring GO 3rd, Wilson LA (1992) Penetrating keratoplasty in patients with rheumatoid arthritis. Ophthalmology 99(4):622–627CrossRefPubMed
Metadata
Title
Corneal melting in rheumatoid arthritis patients treated with a tectonic reinforcing corneolimbal graft: an interventional case series
Authors
Eitan Livny
Michael Mimouni
Irit Bahar
Yair Molad
Assaf Gershoni
Israel Kremer
Publication date
01-06-2018
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 3/2018
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-017-0545-z

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