Sudarvizhi Arumugam1 , Sharmila Devi Vadivelu2 , Niranjan Karthik Senthilkumar3 , Meenakshi Babu4 Sivakami Mohan5
BACKGROUND Peripheral ulcerative keratitis (PUK) is a destructive inflammatory disease of the juxta-limbal corneal stroma that is caused by various infectious and non-infectious ocular and systemic diseases. Certain morphologic and immunologic characteristics of peripheral cornea make it more vulnerable to inflammatory reactions and necrosis. Early diagnosis and prompt treatment prevent blindness due to this devastating inflammatory condition. We wanted to study the aetiology, clinical features and outcome of various treatment modalities of peripheral ulcerative keratitis of non-infective aetiology. METHODS 54 eyes of 40 patients with peripheral ulcerative keratitis of non-infective aetiology were evaluated and treated with either medical or surgical therapy or both in a tertiary care centre and were followed up. The total study duration was 12 months. RESULTS 60 percent of cases were males (24 / 40). The most common age group affected was 60 - 70 years (32.5 %) and the mean age in our study group was 57.7 ± 18.33 years. 65 % were unilateral (26 / 40). In our study 15 eyes (27.77 %) had meibomitis. 13 % of eyes had mild involvement, 40.8 % eyes had moderate involvement, 46.2 % eyes had severe involvement. Severe involvement was the most common presentation. The incidence of perforated PUK in the study group was 20.37 % (11 / 54 eyes). 45 % were found to have unknown aetiology. Of the remaining, the most common aetiology was Mooren's ulcer (32.5 %) followed by rheumatoid arthritis (20 %) and Systemic Lupus Erythematosus (2.5 %). Among 54 eyes, the resolution of signs of active PUK was seen in 50 eyes (92.59 %) after treatment. Visual acuity improvement noted on comparison of mean of pretreatment visual acuity 0.90 with standard deviation 0.39 and the mean of post treatment visual acuity 0.62 with standard deviation 0.37 logarithm of minimum angle of resolution units with P value is < 0.001 which is significant. For perforated peripheral ulcerative keratitis eyes, patch graft was found to be successful in 87.5 %. Peritomy was successful in 100 % and peritomy with amniotic membrane graft was successful in 70 %. CONCLUSIONS In our study, male patients were more than female and the commonest presentation was unilateral. Most common aetiology was idiopathic followed by Mooren's ulcer, rheumatoid arthritis and systemic lupus erythematosus. Mild to moderate cases respond well to medical management. Severe cases need immunosuppressants. Perforated cases needs surgical intervention especially patch graft which is better in achieving good anatomical integrity and enhanced visual acuity. Early referral of patients with peripheral ulcerative keratitis to a tertiary care centre helps in early treatment which is beneficial in avoiding blindness.
