Acute postoperative paracentral corneal melting and perforation after uncomplicated cataract surgery in a patient with inadvertent rheumatoid arthritis

Rodríguez-García, Alejandro; Bustamante-Arias, Andrés; Hernández-Camarena, Julio C.; Loya-García, Denise; Alvarez-Guzman, Carlos; Rodríguez-Gutiérrez, Luis Alberto

doi:10.5935/0004-2749.202100108

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…This has dramatically decreased with the advent of phacoemulsification and microincisional surgery and the wide use of DMRADs. However, RA patients undergoing cataract surgery are still at risk [66,67] and postcataract corneal melt may be the triggering factor for RA diagnosis [67][68][69].…”

Section: Corneal Melts Following Ocular Surgerymentioning

confidence: 99%

Corneal complications of rheumatoid arthritis

Wajnsztajn

Nche

Solomon

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewRheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints. Extra-articular manifestations (EAMs) are common and may affect up to 40.6% of patients. Ocular EAM can occur in 39% of the patients. The cornea is involved by different pathogenic mechanisms and corneal disease varies from mild symptoms to severe corneal ulceration and melting with visual loss. Severe corneal involvement is associated with increased mortality in RA patients. We aimed to review the prevalence, mechanisms, management and overall impact of corneal involvement in RA patients.Recent findingsCorneal involvement is frequent among RA patients. With the wider use of systemic immunosuppression, in particular the disease-modifying antirheumatic drugs (DMARDs), and with improvement of surgical techniques, spontaneous and surgery-related corneal ulceration and melting is becoming less common. However, RA patients are still at risk and should be carefully managed.SummaryRA-related corneal complications are associated with a decreased quality of life and poor ocular and systemic prognosis. Prompt recognition and a multidisciplinary approach involving topical ophthalmic management and systemic immunosuppression are the key factors to maintain ocular integrity and avoid a lethal outcome.

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Section: Corneal Melts Following Ocular Surgerymentioning

confidence: 99%

Corneal complications of rheumatoid arthritis

Wajnsztajn

Nche

Solomon

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Rheumatoid arthritis-associated peripheral ulcerative keratitis outcomes after early immunosuppressive therapy

et al. 2022

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Background/aimsTo evaluate the role of early immunosuppressive therapy (IMT) in the management of rheumatoid arthritis (RA)-associated peripheral ulcerative keratitis (PUK).MethodsSingle-centre, retrospective, comparative cohort study. Patients with RA-associated PUK were divided into two groups; those exposed to and those not exposed to early IMT, defined as administrating therapy within the first 4 weeks from the PUK onset. Outcomes included PUK recurrence, control of inflammation and development of ocular complications, including corneal scarring and perforation, cataract formation or progression and permanent visual loss.ResultsA total of 52 eyes from 36 patients were included for analysis; 37 (71.2%) eyes received early IMT and 15 (28.8%) eyes did not. Follow-up time was 41.2+53.3 months (range: 4–236 months). While early IMT was a protective factor (HR 0.345, 95% CI 0.126 to 0.946, p=0.039), late RA diagnosis after PUK onset (HR 4.93, 95% CI 1.75 to 13.85, p=0.002) and retarded (≥2 months) control of inflammation (HR 8.37, 95% CI 1.88 to 37.16, p=0.005) were risk factors for PUK recurrence. Late IMT (OR 7.75, 95% CI 2.00 to 29.99, p=0.003), an unknown diagnosis of RA at first visit (OR 4.14, 95% CI 1.15 to 14.91, p=0.030) and at least one PUK recurrence (OR 6.42, 95% CI 1.71 to 24.07, p=0.006) were risk factors for visual loss. Survival analysis rendered eyes exposed to early IMT a lower risk of PUK recurrence (p=0.039).ConclusionEyes with RA-associated PUK exposed to early IMT were more likely to achieve earlier inflammatory control, fewer recurrences and had better visual outcomes.

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Risk factors, diagnostics and treatment of corneal melting after cataract phacoemulsification

Svetozarskiy,

Andreev,

Shvaikin

et al. 2023

Rossijskij oftalʹmologičeskij žurnal

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Inflammatory complications of cataract phacoemulsification are among the most urgent and potentially vision-threatening conditions. Corneal melting is a rare but clinically significant condition preceding corneal perforation. The main risk factors are the use of nonsteroidal anti-inflammatory drugs (NSAIDs), severe dry eye disease and rheumatic diseases. The paper presents a literature review and offers an analysis of a clinical case of corneal melting after cataract phacoemulsification in a female patient with severe dry eye disease, which was undiagnosed before surgery. The follow-up period was 5 years. The possibilities and limitations of multiple methods of corneal melting treatment at the stages of persistent epithelial defect and corneal ulcer are discussed. The mechanism of disease development and its link with the pathogenesis of dry eye disease and the role of topical NSAIDs as a trigger for the initiation and progression of corneal melting are considered.

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Acute postoperative paracentral corneal melting and perforation after uncomplicated cataract surgery in a patient with inadvertent rheumatoid arthritis

Cited by 3 publications

References 2 publications

Corneal complications of rheumatoid arthritis

Corneal complications of rheumatoid arthritis

Rheumatoid arthritis-associated peripheral ulcerative keratitis outcomes after early immunosuppressive therapy

Risk factors, diagnostics and treatment of corneal melting after cataract phacoemulsification

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