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

Ho Jang Jae; Joo Ko Youn; Woo Lee Seung

doi:10.3341/jkos.2013.54.5.808

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Jae, Youn, and Seung: A Case of Bilateral Peripheral Ulcerative Keratitis in a Patient with Rheumatoid Arthritis after Cataract Extraction

Original Article

J Korean Ophthalmol Soc 2013;54(5):808-812.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.5.808

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

Ho Jang Jae, MD, Joo Ko Youn, MD, Woo Lee Seung, MD

¹Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Korea

Address reprint requests to Seung Woo Lee, MD Department of Ophthalmology, Dongguk University Gyeongju Hospital #87 Dongdae-ro, Gyeongju 780-350, Korea Tel: 82-54-770-8256, Fax: 82-54-772-9618, E-mail: meinkamf@hanmir.com

Received 31 August 20129 November 2012 Accepted 5 March 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 be-cause of the iris damage by the phacoemulsification tip. Slit lamp examination showed bilateral peripheral ulcerative kerati-tis 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, sulfasa-lazine, and steroid eye drop. After 1 month of treatment, epithelial thinning of the cornea and peripheral corneal ulcer stop-ped progressing and showed corneal re-epithelization.

Conclusions

Because peripheral ulcerative keratitis after cataract extraction with clear corneal incision can occur in a pa-tient with rheumatoid arthritis, caution is necessary to minimize damage by careful manipulation during the operation and requires special attention in preoperative and postoperative management.

Keywords: Cataract surgery, Peripheral ulcerative keratitis, Rheumatoid arthritis

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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).

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.

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