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Aggressive systemic anti-inflammatory shown to be successful in ulcerative keratitis

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In a study to assess the management of peripheral ulcerative keratitis, researchers found that associated ocular morbidity has fallen, likely due to more aggressive systemic anti-inflammatory therapy.

Knox Cartwright and colleagues detailed the 10-year study of patients who attended a specialist corneal immunosuppression clinic in Cornea.

Of the 70 patients included, 21% had bilateral disease, and 66% had rheumatoid arthritis (RA), and the average age of the patients was 65 years. Every patient was prescribed systemic corticosteroids, according to the study, and they were later stopped in 64% of the patients.

With the exception of two patients, all were treated with steroid-sparing immunosuppressive agents; patients were prescribed an average of 1.5 medications, including prednisolone. The medication breakdown was as follows: prednisolone (100%), methotrexate (67%), mycophenolate (21%), tacrolimus (7%) and azathioprine (6%). The researchers noted that no irreversible side effects occurred as a result of the medications.

Additionally, within the RA group, the researchers found that 12 eyes of 11 patients underwent a corneal transplantation after perforation, and 83% remained clear. The group of RA patients had significantly lower rates of corneal perforation when compared to the other group, according to the study.

"These results are consistent with the concept that recent changes toward more aggressive systemic anti-inflammatory therapy have reduced the severity and morbidity of ulcerative keratitis," the authors concluded. "This was manifest not only as improved visual and anatomical outcomes but also as reduced disease severity, implied by the smaller proportion of eyes developing corneal perforation. No irreversible systemic adverse effects were caused by immunosuppressive therapy, and mortality did not increase. For these reasons, it is recommended that clinicians should have a low threshold for initiating immunosuppressive treatment in patients presenting with ulcerative keratitis."