AB1399 SHORT-TERM OUTCOMES OF IMMUNOSUPPRESSIVE TREATMENT IN SEVERE PERIPHERAL ULCERATIVE KERATITIS: A RETROSPECTIVE STUDY FROM A TERTIARY HEALTHCARE CENTRE
Authors: A. Patankar, S. Yadav, R. Shukla, S. Mulkutkar, S. Shaha, G. Sachdev, B. Swain, C. Balakrishnan, R. Samant
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Peripheral Ulcerative Keratitis (PUK) is a rare corneal disorder characterised by progressive juxta-limbal corneal stromal degradation, thinning, perforation, and an increased risk of visual loss [1]. This inflammation can be idiopathic (Mooren's ulcer) or secondary to systemic inflammatory diseases, such as ANCA vasculitis, Rheumatoid arthritis and SLE. Management of PUK depends on its severity and underlying cause [2]. It includes aggressive systemic immunosuppressive therapy with or without surgical intervention to prevent permanent visual loss. <h3>Objectives:</h3> To assess the short-term outcome of immunosuppressive therapy used in treating severe PUK. <h3>Methods:</h3> This retrospective case series encompassed all cases of severe PUK treated at our tertiary healthcare centre from 2015 to 2023. Severe PUK was defined as more than 50% corneal thinning, with impending perforation or corneal melt. The absence of infection was confirmed through a corneal scrape. Responses were evaluated as complete response (absence of clinical symptoms, total improvement in visual acuity, no stromal inflammation or progressive corneal thinning), incomplete response (lack of clinical symptoms, with incomplete improvement in visual acuity and persistent stromal inflammation but no progressive corneal thinning) and no response (persistent clinical symptoms, with no improvement in visual acuity, persistent stromal inflammation and progressive corneal thinning). <h3>Results:</h3> 12 patients and 18 eyes were included (6 bilateral and 6 unilateral). Of these, 9 were female, with a median age of 56.5 years (IQR 49-64.5 years). RA was the primary cause in 9 patients (66%), followed by Mooren's (Idiopathic) in 3(25%), and GPA in 1(9%). PUK was the presenting feature in 4 patients (33%). In the RA group, PUK appeared after a median period of 16 years (IQR 6-14 years). Common symptoms included eye pain, redness, diminished vision and photophobia. All the patients had visual acuity below 6/18. Corneal thinning was a prevalent ocular manifestation, with 8 (67%) patients having corneal melt. All patients received pulse methylprednisolone (500mgx3 doses) followed by oral steroids (0.5mg/kg/day) and immunosuppressive medications. 11 patients received intravenous cyclophosphamide (500mg every 2 weekly x 6 doses) followed by oral methotrexate (15-25mg/week) in 4 patients. Surgical intervention was performed in 9 patients and comprised of amniotic membrane graft, bandage contact lens adhesive with glue and conjunctival resection (Figure 1). Outcomes assessed at 1, 3, and 6 months, indicated a favourable response to treatment, with a progressive increase in complete response over time. The median prednisolone dose showed a decreasing trend, reflecting the therapeutic efficacy of the other interventions (Figure 2). At the end of 6 months, 9 (75%) patients showed a good response to treatment. However, even after the above immunosuppressive regimen, 5 (28%) eyes were lost (visual acuity &lt;6/60), showing an increasing need for better treatment along with early referral and collaborative management. <h3>Conclusion:</h3> These findings provide valuable insights into management outcomes of severe PUK, shedding light on potential areas for further research and therapeutic advancement in the field. <h3>REFERENCES:</h3> [1] Sharma N, Sinha G, Shekhar H, Titiyal JS, Agarwal T, Chawla B, et al. Demographic profile, clinical features and outcome of peripheral ulcerative keratitis: a prospective study. Br J Ophthalmol. 2015 Nov;99(11):1503–8. [2] Ashar JN, Mathur A, Sangwan VS. Immunosuppression for Mooren's ulcer: evaluation of the stepladder approach—topical, oral and intravenous immunosuppressive agents. Br J Ophthalmol. 2013 Nov;97(11):1391–4. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>