Nölle B., Amm M., Schröder J. O.

Klinik für Ophthalmologie, Universität Kiel, Hegewischstr. 2, 24105 Kiel

Objective: Corneal melting in rheumatoid arthritis is a main challenge for every ophthalmologist. Treatment of such a patient is more complex, if alcohol abuse, sicca-syndrome and a secondary bacterial infection complicate the disorder.
Methods: A case report is given with two variants applied in addition to the routine procedure: 1. a TNF-a-antagonist (Enbrel®) was applied, 2. a lamellar paracentral corneal patch graft was performed using Gore-Tex®.
Results: After isolation of the micro-organisms the applied local antibiotics were successful. However, within six weeks a descemetocele developed in both eyes. Therefore, a penetrating keratoplasty à chaud was performed in the left eye. Because of paracentral small descemetocele a Gore-Tex® patch graft was performed in the right eye. Meanwhile this patch graft stabilises for 18 month this eye, visual acuity was good, reaching values up to 0.4. Because of complicated constellation from the view point of the rheumatologist, they decided to first treat chronic polyarthritis with Enbrel®. Within four weeks arthritis and eye symptoms improved. Meanwhile immunosuppression is continued with azathioprine.
Conclusion: A TNF-a-antagonist seems to be promising in the treatment of rheumatoid keratomalacia. It seems to work very fast. Local treatment possibilities are desirable. Instead of an allogeneic tissue, which in some cases will melt also, the use of Gore-Tex® seems advisable.

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