Peripheral ulcerative keratitis

Gupta, Yogita; Kishore, Alisha; Kumari, Pooja; Balakrishnan, Neelima; Lomi, Neiwete; Gupta, Nidhi; Vanathi, Murugesan; Tandon, Radhika

doi:10.1016/j.survophthal.2021.02.013

Cited by 46 publications

(83 citation statements)

References 163 publications

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“…In the latter, half (2/4) of affected patients (2% [2/98] of the total SLE sample) had peripheral ulcerative keratitis (PUK), a subtype recognised to occur in association with systemic autoimmune disease and carry a poorer prognosis. 52 This is similar to the overall prevalence of PUK observed in other autoimmune disorders (1.8% [2/ 112]) in relapsing polychrondritis 53 and 1.0% (6/589) in rheumatoid arthritis, 54 and higher than the 0.02% observed in the general population. 55 Uveitis.…”

Section: Prevalencesupporting

confidence: 84%

Epidemiology of disease-activity related ophthalmological manifestations in Systemic Lupus Erythematosus: A systematic review

Jawahar¹,

Walker²,

Murray

et al. 2021

Lupus

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Objective Ophthalmic complications in Systemic Lupus Erythematosus (SLE) are broad and can occur in up to a third of patients. The British Isles Lupus Assessment Group (BILAG) 2004 Index identifies 13 ocular manifestations of active SLE, as opposed to those related to previous disease activity and/or the consequences of therapy. We conducted a systematic review of published literature to determine the frequency of ophthalmic manifestations of active SLE. Methods A systematic literature search of Ovid MEDLINE and EMBASE from their respective inceptions to July 2020 was conducted to identify cohort, case–control and cross-sectional studies. Results 22 studies meeting eligibility criteria were included. Most studies featured small sample sizes and were judged to have a high risk of methodological bias. The number and quality of studies did not allow us to confidently estimate the incidence of the conditions. No studies reported epidemiological data for orbital inflammation/myositis/proptosis. The prevalence of each of the other ocular manifestations, with the exception of retinal vaso-occlusive disease, was consistently less than 5%. Retinal vasculitis, uveitis and isolated cotton wool spots tended to be associated with more active SLE disease. Conclusion The prevalence of eye disease due to SLE activity is uncommon, but clinicians should be aware that some conditions tend to be associated with more active systemic disease. Further studies to determine the incidence and risk factors for these ophthalmic manifestations are needed.

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Section: Prevalencesupporting

confidence: 84%

Epidemiology of disease-activity related ophthalmological manifestations in Systemic Lupus Erythematosus: A systematic review

Jawahar¹,

Walker²,

Murray

et al. 2021

Lupus

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“…AMT or AMT combined with corneal or conjunctival grafts has also been used in Mooren's ulcer, PUK, and other immune-related PED with or without corneal ulcer and perforation. [ 66 67 68 69 70 71 72 73 ] PUK is a group of corneal disorders that cause peripheral corneal thinning, usually associated with systemic autoimmune diseases,[ 74 ] while Mooren's ulcer is an idiopathic, noninfectious, painful, and progressive PUK which is thought to be an autoimmune disease in the absence of any diagnosable systemic disorder. [ 75 ] The management should start from an accurate diagnosis by ruling out bacterial, fungal, or Acanthamoeba infections.…”

Section: Clinical Evidence Of Amniotic Membrane Transplantation In Mooren's Ulcer Peripheral Ulcerative Keratitis and Other Immune-relatementioning

confidence: 99%

Update on the application of amniotic membrane in immune-related ocular surface diseases

Chen

Lao

Liang

2021

Taiwan J Ophthalmol

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Immune-related ocular surface diseases, a group of diseases in which immune dysregulation damages the ocular surface, can induce uncontrolled inflammation and persistent epithelial defect, thus leading to the most severe forms of acute keratoconjunctivitis, dry eye disease, epithelial keratitis, stromal ulceration, and corneal perforation. As these diseases are often refractory to treatments, they have a threatening impact on the vision and life quality of patients. This review summarizes the current literature regarding the clinical application of sutured and self-retained cryopreserved amniotic membrane (AM) in treating Stevens–Johnson syndrome/toxic epidermal necrolysis, ocular graft-versus-host disease, Sjögren's syndrome, Mooren's ulcer, and peripheral ulcerative keratitis. Current evidence supports the safety and effectiveness of AM, especially self-retained cryopreserved AM, in decreasing ocular surface inflammation, promoting corneal epithelial and stromal healing, improving visual acuity, and preventing sight-threatening complications. Future studies are still required to validate the above findings and explore the varied application methods of AM to improve the clinical efficacy in maintaining ocular surface health.

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“…Peripheral ulcerative keratitis (PUK) is a rare inflammatory disease of the peripheral cornea with an incidence of 0.2-3.0 per million population per year. 1 It is characterised by a juxtalimbal crescent shaped epithelial defect, stromal thinning and inflammatory stromal infiltrate. 1 Peripheral ulcerative keratitis develops in the peripheral cornea because of its unique anatomical and physiological characteristics.…”

Section: Introductionmentioning

confidence: 99%

“…1 It is characterised by a juxtalimbal crescent shaped epithelial defect, stromal thinning and inflammatory stromal infiltrate. 1 Peripheral ulcerative keratitis develops in the peripheral cornea because of its unique anatomical and physiological characteristics. 1 It is associated with many local and systemic conditions that are broadly classified into infective and non-infective.…”

Section: Introductionmentioning

confidence: 99%

“…1 Peripheral ulcerative keratitis develops in the peripheral cornea because of its unique anatomical and physiological characteristics. 1 It is associated with many local and systemic conditions that are broadly classified into infective and non-infective. 1 Peripheral ulcerative keratitis is an important condition as the presence of comorbid systemic disease is associated with significant morbidity and increased mortality.…”

Section: Introductionmentioning

confidence: 99%

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Peripheral ulcerative keratitis: A review of aetiology and management

Hӧllhumer

2022

African Vision and Eye Health

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Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory disease of the peripheral cornea that can be caused by local factors or systemic inflammatory disease.Aim: The purpose of this review is to give an overview of the pathophysiology, aetiology, clinical features, diagnosis, and management of PUK.Method: A PubMed search was conducted using the keywords, ‘peripheral ulcerative keratitis’ and ‘Mooren’s ulcer’.Results: The peripheral cornea has unique characteristics the predispose to the development of PUK. These include fine capillary arcades that allow for deposition of immune complexes and subsequent activation of an inflammatory cascade with corneal melt. Several conditions have been implicated in the aetiology of PUK. The most commonly cited causes are rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA) and various dermatoses. In patients with RA, PUK usually presents in established disease, whereas in GPA, PUK may be the presenting feature in up to 60% of cases. In RA it heralds the onset of a systemic vasculitis with significant associated morbidity and mortality. The management of PUK follows an individualised stepwise approach. All patients require supportive measures to encourage healing and halt the process of keratolysis. Systemic autoimmune conditions need a systemic corticosteroid as a fast-acting agent to halt the inflammatory process while cytotoxic therapy maintains long term disease control. Failure to achieve disease control with CTT, necessitates the use of a biologic agent.Conclusion: Peripheral ulcerative keratitis is a severe inflammatory disease of the peripheral cornea that needs a thorough diagnostic workup and stepwise management approach.

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Peripheral ulcerative keratitis

Cited by 46 publications

References 163 publications

Epidemiology of disease-activity related ophthalmological manifestations in Systemic Lupus Erythematosus: A systematic review

Epidemiology of disease-activity related ophthalmological manifestations in Systemic Lupus Erythematosus: A systematic review

Update on the application of amniotic membrane in immune-related ocular surface diseases

Peripheral ulcerative keratitis: A review of aetiology and management

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