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Outcome of penetrating keratoplasty in rheumatoid arthritisU. Pleyer, P. Rieck, E. Bertelmann
Background: Keratolysis in rheumatoid arthritis is a well recognized disorder that may rapidly destroye the entire corneal stroma, resulting in descemetocele formation and eventually corneal perforation. The purpose of this study was to determine the anatomical and functional results of therapeutic penetrating keratoplasty (PK) in these patients.
Patients and methods: We reviewed the records of patients receiving PK over a five year period and evaluated the outcome. In 13 eyes of 12 patients PK were performed (graft diameter: 3.0 -11.0 mm) because of corneal melting with perforation or descemetocele formation. In nine eyes we have used topical cyclosporine A (2%) as an adjunct therapy after transplantation in addition to systemic immunosuppressive agents.
Results: Following a mean follow-up time of 17 months, anatomical success could be achieved in all eyes; none of the eyes underwent enucleation or evisceration. Postoperative complications following the first PK were epithelial keratopathy in 7 eyes (54%), corneal ulcerations in 3 eyes (23%), fistulation in 3 eyes (23%), suture loosing in 2 eyes (15.4%), graft rejection in 1 eye (7.7%). Additional 8 regrafts were required because of recurrence of corneal melting or persistent deep stromal defects. There was a tendency toward lower recurrence of corneal melt in patients receiving topical cyclosporin, but this observation did not reach statistical significance (p>0.05). The final best corrected visual acuity was 20/40 in 4 eyes, but limited to 20/200 or less in 7 eyes.
Conclusion: Whereas PK can be successfull to restore the anatomical integrity of severely alterated eyes, the high prevalence of complications limit the indication for PK as a last stage procedure when other methods of management have failed. In patients with rheumatoid arthritis the prognosis is poor for vision.
Dept. of Ophthamology, Chrité, Humboldt University, 13353 Berlin
Supported by DFG (Pl 150/9-1).