Justus W Thomas1, Stephen C Pflugfelder. 1. Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA.
Abstract
PURPOSE: To review the relative efficacy of the TNFalpha antagonist infliximab in treating 3 patients with rheumatoid arthritis-associated peripheral ulcerative keratitis. METHODS: Review of the clinical course of 3 nonconsecutive patients with progressive rheumatoid arthritis-associated peripheral ulcerative keratitis who were initially treated with conventional immunosuppressant therapy and subsequently treated with infliximab. RESULTS: All 3 patients experienced progressive corneal ulceration on oral prednisone and weekly oral or intramuscular methotrexate. They all demonstrated a marked reduction in conjunctival injection, closure of their corneal epithelial defects, and arrest of corneal thinning after receiving infliximab. Two out of 3 patients required patch grafts for treatment of corneal perforations before starting infliximab, and they had no further keratolysis after receiving this agent. CONCLUSIONS: Infliximab was effective in arresting progressive rheumatoid arthritis-associated peripheral ulcerative keratitis that was refractory to conventional immunomodulatory therapy.
PURPOSE: To review the relative efficacy of the TNFalpha antagonist infliximab in treating 3 patients with rheumatoid arthritis-associated peripheral ulcerative keratitis. METHODS: Review of the clinical course of 3 nonconsecutive patients with progressive rheumatoid arthritis-associated peripheral ulcerative keratitis who were initially treated with conventional immunosuppressant therapy and subsequently treated with infliximab. RESULTS: All 3 patients experienced progressive corneal ulceration on oral prednisone and weekly oral or intramuscular methotrexate. They all demonstrated a marked reduction in conjunctival injection, closure of their corneal epithelial defects, and arrest of corneal thinning after receiving infliximab. Two out of 3 patients required patch grafts for treatment of corneal perforations before starting infliximab, and they had no further keratolysis after receiving this agent. CONCLUSIONS:Infliximab was effective in arresting progressive rheumatoid arthritis-associated peripheral ulcerative keratitis that was refractory to conventional immunomodulatory therapy.
Authors: Miguel Cordero-Coma; Raquel Salazar Méndez; Alvaro Casado Blanco; Ana López Corral; Sara Calleja-Antolín; José M Ruiz de Morales Journal: J Ophthalmic Inflamm Infect Date: 2012-05-16