J Korean Ophthalmol Soc.  2013 May;54(5):808-812. 10.3341/jkos.2013.54.5.808.

A Case of Bilateral Peripheral Ulcerative Keratitis in a Patient with Rheumatoid Arthritis after Cataract Extraction

• Jang JH
• Ko YJ
• Lee SW

• KMID: 2217051
• DOI: http://doi.org/10.3341/jkos.2013.54.5.808

Abstract

PURPOSE
To report a case of bilateral peripheral ulcerative keratitis after cataract extraction with a clear corneal incision in a patient with rheumatoid arthritis.
CASE SUMMARY
A 67-year-old woman was referred to our clinic with bilateral ocular pain and visual disturbances, 10 days after a cataract extraction in her right eye. The patient had undergone a cataract extraction with clear corneal incision in the left eye and the same procedure was performed in the right eye after 1 week. During the surgery, hyphema occurred because of the iris damage by the phacoemulsification tip. Slit lamp examination showed bilateral peripheral ulcerative keratitis around the incision site and diffused corneal edema. Topical instillation and systemic administration of antibiotic agents were given as treatment but the patient showed no improvement. Corneal culture and smear were performed and showed a negative result. Because the patient was previously diagnosed with rheumatoid arthritis and showed the characteristic finger deformity, she was diagnosed with a sterile peripheral ulcerative keratitis and was treated with oral steroid, sulfasalazine, and steroid eye drop. After 1 month of treatment, epithelial thinning of the cornea and peripheral corneal ulcer stopped progressing and showed corneal re-epithelization.
CONCLUSIONS
Because peripheral ulcerative keratitis after cataract extraction with clear corneal incision can occur in a patient with rheumatoid arthritis, caution is necessary to minimize damage by careful manipulation during the operation and requires special attention in preoperative and postoperative management.

Keyword

Cataract surgery; Peripheral ulcerative keratitis; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid
Cataract
Cataract Extraction
Congenital Abnormalities
Cornea
Corneal Edema
Corneal Ulcer
Eye
Female
Fingers
Humans
Hyphema
Iris
Phacoemulsification
Sulfasalazine
Ulcer
Sulfasalazine

Figure

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  Figure 1. (A) Right eye (B) Left eye. Peripheral ulcerative keratitis is easily visualized in the clear corneal incision site (white arrow) and paracentesis sites (black arrows) with the intense conjunctival injection in both eyes. Photograph (A) shows blood clot in the anterior chamber around the main incision site (white arrow head).

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  Figure 2. (A, B) Right eye, (C, D) Left eye. Photographs show the state of the eyes 3 months after cataract extraction. Photograph (A) and (B) show a crescent shaped corneal thinning (black arrow) after re-epithelialization. Photograph (C) and (D) show a peripheral circumferential corneal thinning (white arrow) after re-epithelialization.

Reference

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