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Case Reports in Ophthalmological Medicine
Volume 2012 (2012), Article ID 173793, 3 pages
http://dx.doi.org/10.1155/2012/173793
Case Report

Stabilization of Bilateral Progressive Rheumatoid Corneal Melt with Infliximab

1Academic Rheumatology and Osteoporosis Unit, Whipps Cross Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK
2Department of Ophthalmology, Whipps Cross Hospital, London E11 1NR, UK

Received 10 February 2012; Accepted 4 April 2012

Academic Editors: C. Giusti and C. G. Kiss

Copyright © 2012 Sheelah F. Antao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. To report the use of infliximab in the rapid stabilization of a case of progressive, bilateral rheumatoid peripheral ulcerative keratitis (PUK) that failed to respond to conventional immunosuppressive therapy. Methods. A single interventional case report. Results. A patient with rheumatoid arthritis presented with bilateral PUK following a 2-month history of ocular discomfort and redness. His systemic prednisolone (PDN) and methotrexate (MTX) were increased and, despite an initial favorable response, bilateral recurrent corneal perforations ensued. Both eyes underwent cyanoacrylate glue repair, amniotic membrane transplantation (AMT), and penetrating keratoplasty (PKP). Recurrence of the disease and bilateral perforations of the second PKP in both eyes prompted administration of intravenous infliximab immediately after the fourth PKP. The disease activity rapidly settled in both eyes, and at eighteen-month followup, after 12 infliximab infusions, the PUK remains quiescent with no further graft thinning or perforation. Conclusion. Infliximab can be used to arrest the progression of severe bilateral rheumatoid PUK in cases that are refractory to conventional treatment.