Posters

Surgical controversies in the management of autoimmune diseases of the cornea: two case reports

Poster Details

First Author: C.Alba Linero SPAIN

Co Author(s):    M. Rodriguez Calvo de Mora   T. Lupion Duran                 

Abstract Details

Purpose:

To show the outcomes of two cases after advanced surgical treatment in the context of a severe autoimmune systemic disease.

Setting:

Cornea and Ocular Surface Department of a Tertiary Referral Ophthalmologic Hospital H.R.U M�Ã�¡laga

Methods:

Case 1: A 66 years old rheumatoid-arthritis female patient was admitted in our Emergency Department with diffuse bilateral corneal melting. In the right eye (OD), central corneal thickness was 150 microns and in the left eye (OS) a central perforation with atalamia was observed. Case 2: A 72 years old female patient with previous known severe Chronic Graft-Versus-Host Disease (GVHD) was referred for low visual acuity and excruciating pain OS. A dense central corneal calcic deposit in the OS and severe inflammation of the ocular surface OS with absence of corneal epithelium was noted.

Results:

Case 1: Emergency keratoplasty was planned for the OS. Corneal debridement of the melting area and customized deep anterior lamellar keratoplasty (DALK) with overlying amniotic membrane was performed. Despite maximal topical immunosupressant medication, the graft showed signs of melting. A re-graft was performed adding systemic immunosupressant medication. Case 2: After intensive topical treatment OS and corneal scraping combined with EDTA in OS, a sterile inflammation with pseudohipopion was observed together with a worsening of the surface symptoms in the OS. Due to the general condition of the patient and the non-resposive outcome of the surgery, a conservative treatment was advocated.

Conclusions:

When severe and poorly-controlled immune diseases affect the cornea or the ocular surface, a complicated course of the condition is advanced. Frequently, the outcomes of corneal surgery in these patient are discouraging. However, the prognosis can be improved when adequate systemic immunosupressant medication is combined with topical and surgical therapy. Proper communication with internal medicine and rheumatologist specialists is key to manage these challenging cases.

Financial Disclosure:

NONE