Purpose: To retrospectively investigate the clinical courses of the cases of rheumatoid corneal ulcer perforation.
Methods: We enrolled 13 patients (males, 3; females, 10) with rheumatoid corneal ulcers who were treated at our hospital on an outpatient basis for corneal perforation. The investigated items included their age during perforation, sex, a history of rheumatoid arthritis, complications, perforated site, treatment details, and prognosis.
Results: The mean age of the patients at the time of perforation was 70.9±7.8 years (mean±standard deviation), and the mean follow-up period was 36.5±29.1 months. Of these patients, only four were not diagnosed with rheumatoid arthritis. The perforation sites included the edge of the pupil in four patients, the middle area in five patients, the outermost peripheral area in three patients, and an indefinite area in one patient. Initially, all patients underwent a conservative treatment, which remarkably led to successful perforation closure in four patients. Of the remaining nine patients, six showed perforation improvement following lamellar keratoplasty and three showed improvement following penetrating keratoplasty. Recurrence was noted in two of the four patients who showed improvement with the conservative treatment. However, corneal infections developed in five patients during the course of the treatment.
Conclusions: Rheumatoid corneal perforation can subsequently lead to the diagnosis of rheumatoid arthritis. The middle area of the pupil was a more common site of perforation than the edge or outermost peripheral area of the pupil. Although adrenocorticosteroid instillation and corneal transplantation are effective methods of treatment, corneal infections should be cautiously monitored during the course of the treatment.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 700-704, 2018.