Abstract

P 186

Therapy of severe rheumatoid corneal ulcer with inactive rheumtoid disease: two cases

Mayweg S., Spelsberg H.
Department of Ophthalmology, Universitätsklinikum Düsseldorf 

Objective: Melting corneal processes occur despite clinically inactive and sufficiently treated rheumatoid disease. This is a big interdisciplinay therapeutic challenge. No therapeutic gold standard exists in these cases. Herein, three patients are presented with perforated corneal ulcers of different size, who urgently needed an individual immunosuppressive therapy regimen after emergency keratoplasty even in case of inactive rheumatoid disease.
Methods: Two patients with perforated corneal ulcers due to rheumatoid disease were treated with a tectonic emergency keratoplasty (P1) and a conventional emergency keratoplasty (P2). The rheumatoid disease was inactive in both. These patients received prednisolone 1.5 mg/kg body weight at the beginning of the therapy. Despite an additional immunosuppressive therapy started after surgical treatment with methotrexate (P2) and cyclosporine A (P1), both experienced a new melting perforation after slow prednisolone reduction under an individual threshold of 7.5 mg (P1) and 10 mg (P2). Both eyes could be stabilized without another surgical procedure under prednisolone 1.5 mg/kg body weight in the acute phase and with a therapeutic soft contact lens. Additionally to their immunosuppressive regimens, these patients were treated with therapeutic soft contact lenses and with low-dose prednisolone above the individual threshold for several months.
Results: Additional systemic steroids above the individual threshold and therapeutic soft contact lenses led to stable corneal situations. Best corrected visual acuity was 0.63 (P1) and 0.1 (P2). Another surgical procedure could be avoided so far.
Conclusions: Even if the rheumatoid disease is inactive and sufficiently treated from the rheumatologist’s point of view, melting corneal processes urge to strengthen the immunosuppressive regimen. Additional low-dose systemic steroids given for a longer time are useful in these situations.

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