Posters

Corneal melt and perforation in an undiagnosed primary Sjögren’s syndrome: medical vs surgical management

Poster Details

First Author: E.Alfonso-Muñoz SPAIN

Co Author(s):    E. Fernandez-Lopez   M. Hernandez-Diaz   M. Roig-Revert   R. Araujo-Miranda   M. Garcia-Domene   C. Peris-Martinez     

Abstract Details

Purpose:

Clinical cases of corneal melting (keratolysis) and perforation in Sjögren’s Syndrome (SS) have been described for many years. Nevertheless, their complex management, their catastrophic ocular consequences and the new therapeutic options make necessary the continued update of their management. By comparing, in the same patient, the response to medical treatment in one eye with the course of surgical management in the other eye, the purpose of this poster is to highlight the importance of medical treatment in controlling autoinmunne eye disesases and the potential role of ReGeneraTing Agents (RGTA) in this control.

Setting:

FISABIO-Oftalmología Médica, Valencia, Spain.

Methods:

We report a case of a 61 year old woman, with spontaneous corneal perforation of 1 mm at the right eye (RE) and sterile melting of 1.5x1.5 mm at the left eye (LE) in an undiagnosed primary SS patient. In the RE we decided to make an urgent penetrant tectonic keratoplasty, in the LE, after 10 days of unsuccessful treatment with preservative-free hyaluronate 0.4% eye drops and ciprofloxacin ointment we added RGTA-Cacicol®.

Results:

After the first tectonic keratoplasty, 5 more surgical interventions had to be done due to melting complications in RE, including 3 more corneal transplants, 1 amniotic membrane graft and finally a Gundersen’s conjunctival flap. In LE, we objectified a significant improvement two days after RGTA-Cacicol® introduction. 14 days after starting Cacicol® the corneal defect had almost closed and the danger of perforation had already disappeared. Concurrently a primary SS was diagnosed, thus we added topical cyclosporine 1%, and oral prednisolone and rituximab as systemic treatment. 20 months after RGTAs 20 days treatment any recurrence has been objectified.

Conclusions:

Controlling corneal ulcers and melting in autoimmune diseases as SS with non-surgical treatment allows us to avoid a probably difficult and complicated surgical manage. Clinical recommendations for non-surgical melting management consider essential an effective systemic immunosuppression joined to a topical treatment consisting in discontinuing epithelium toxic eye drops, instituting frequent lubrication with a non-preserved drop or ointment followed by autologous serum and treating any sign of infection. In addition, RGTA-Cacicol® could be useful if no cure or high risk of progression is present: bilateral corneal melting, no improvement after 48h of medical treatment or progression in corneal thinning.

Financial Disclosure:

None