Peripheral ulcerative keratitis after trabeculectomy in a patient with rheumatoid arthritis.
OBJECTIVE
To report the unusual occurrence of peripheral ulcerative keratitis, 10 days after trabeculectomy in a 35-year-old patient with rheumatoid arthritis (RA).


METHODS
Observational case report.


RESULTS
A 35-year-old patient with RA and secondary Sjögren disease underwent an uneventful fornix-based trabeculectomy. Ten days after surgery, slit-lamp examination revealed a peripheral corneal ulcer extending from 5- to 7-o'clock positions with a surrounding inflammatory infiltrate and adjacent conjunctival injection. The ulcer was treated with systemic and topical steroids, antibiotic eyedrops, artificial tears, and a bandage soft contact lens. Since then, corneal re-epithelialization started and the patient's symptoms subsided. The ulcer improved steadily within 2 months while the patient used a soft contact lens. The ulcer did not reoccur in the 18 months follow-up while the patient remained under systemic treatment.


CONCLUSIONS
This report highlights the importance of careful examination and close postoperative follow-up in patients with RA undergoing any intraocular surgery, to diagnose a possible development of peripheral ulcerative keratitis. Although the incidence is rare, prompt diagnosis of the peripheral ulceration is essential because if untreated it may seriously affect patient's vision.
Papaconstantinou
Dimitris
D
Department of Ophthalmology, G Gennimatas Hospital, University of Athens, Athens, Greece.
Georgopoulos
Gerasimos
G
Kalantzis
George
G
Krassas
Augustinos
A
Georgalas
Ilias
I
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications*; D003263:Contact Lenses, Hydrophilic; D003320:Corneal Ulcer / Q000209:etiology* / Q000628:therapy; D005260:Female; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007634:Keratitis / Q000209:etiology* / Q000628:therapy; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011183:Postoperative Complications; D012859:Sjogren's Syndrome / Q000150:complications; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D014130:Trabeculectomy
D000900:Anti-Bacterial Agents; D009883:Ophthalmic Solutions; D013256:Steroids