Peripheral Ulcerative Keratitis and Corneal Melt: A 10-Year Single Center Review With Historical Comparison
Peripheral Ulcerative Keratitis and Corneal Melt: A 10-Year Single Center Review With Historical Comparison
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DOI：
10.1097/ico.0000000000000008
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发表时间：
2014-01-01
期刊：
影响因子：
2.8
通讯作者：
Cook, Stuart D.
中科院分区：
文献类型：
--
作者：
Cartwright, Nathaniel E. Knox;Tole, Derek M.;Cook, Stuart D.
目的：近年来，非感染性溃疡性角膜炎（UK）和相关系统性疾病的治疗发生了变化。本研究的目的是分析最近的一个队列的患者与英国在这方面的context.Methods：2002年6月和2012年7月之间参加一个专业的角膜免疫抑制诊所的所有患者的病例记录进行了审查。将患有类风湿性关节炎（RA）的那些患者与来自同一中心的早期报告中包括的那些患者进行亚组比较（Malik等人，Eur J Ophthalmol. 2006; 16：791 - 797）。Fisher精确检验用于统计学比较，和Bonferroni校正applied.Results：70例患者，其平均年龄为65.0岁（中位数，64岁），包括在内。15例（21%）患有双侧疾病，46例（66%）患有RA。就诊时，平均（中位）视力（VA）为0.59（0.18）最小分辨角的对数，相当于6/24（6/9）Snellen。所有患者均接受了全身性皮质类固醇治疗，45例（64%）患者随后停用。除2例外，所有患者均接受类固醇保留免疫抑制剂治疗，每例患者平均处方1.5种药物（范围0 - 4），包括泼尼松龙。这些药物包括泼尼松龙（70，100%）、甲氨蝶呤（47，67%）、霉酚酸酯（15，21%）、他克莫司（5，7%）和硫唑嘌呤（4，6%）。未发生不可逆的副作用。穿孔后，11例患者（16%）的12只眼接受了角膜移植，其中10例（83%）保持透明。最后一次观察时患眼的平均（中位数）VA为0.34（0.18）最小分辨角的对数，相当于6/13（6/9）Snellen。RA患者的子集有显着降低率的角膜穿孔和VA 6/60时，最后一次看到（P <0.05）相比，较早的cohol.Conclusions：与UK相关的眼部发病率下降，可能是因为走向更积极的系统性视网膜病变治疗。
Purpose:Management of noninfectious ulcerative keratitis (UK) and associated systemic disorders has changed over recent years. This study aimed to analyze a recent cohort of patients with UK in this context.Methods:The case notes of all the patients attending a specialist corneal immunosuppression clinic between June 2002 and July 2012 were reviewed. A subgroup comparison of those with rheumatoid arthritis (RA) was made with those included in an earlier report from this same center (Malik et al. Eur J Ophthalmol. 2006;16:791-797). The Fisher exact test was used for statistical comparison, and a Bonferroni correction was applied.Results:Seventy patients, whose mean age was 65.0 years (median, 64 years), were included. Fifteen (21%) had bilateral disease, and forty-six had RA (66%). At presentation, the mean (median) visual acuity (VA) was 0.59 (0.18) logarithm of the minimum angle of resolution equivalent to 6/24 (6/9) Snellen. All the patients were prescribed systemic corticosteroids, which were later stopped in 45 (64%) patients. All but 2 were treated with steroid-sparing immunosuppressive agents, with each patient being prescribed a mean of 1.5 medications (range, 0-4), including prednisolone. These included prednisolone (70, 100%), methotrexate (47, 67%), mycophenolate (15, 21%), tacrolimus (5, 7%), and azathioprine (4, 6%). No irreversible side effects occurred. After perforation, 12 eyes of 11 patients (16%) underwent a corneal transplantation, and 10 (83%) of these remained clear. The mean (median) VA of the affected eyes when last seen was 0.34 (0.18) logarithm of the minimum angle of resolution equivalent to 6/13 (6/9) Snellen. The subset of patients with RA had significantly lower rates of corneal perforation and a VA 6/60 when last seen (P < 0.05) compared with that of the earlier cohort.Conclusions:Ocular morbidity associated with UK has fallen, possibly because of a move toward more aggressive systemic antiinflammatory therapy.