Management of Corneal Melting Associated with Rheumatoid Arthritis-3 Cases Reports

目的：報告三例周邊角膜潰瘍併穿孔的類風濕性關節炎病患，分別成功的以不同方法治療。方法：病例報告。結果：案例一，七十七歲男性接受眼翳切除後產生週邊角膜溶蝕併穿孔，在無法獲得角膜捐贈情況下，接受鞏膜移植及結膜瓣覆蓋。案例二，五十三歲女性因周邊角膜潰瘍併穿孔住院，接受治療性隱形眼鏡治療，兩週內角膜上皮再生完成。案例三，七十歲女性產生中心旁角膜溶蝕併穿孔，緊急接受人類羊膜移植及治療性隱形眼鏡覆蓋，一週內達到角膜上皮再生。此三位病患追蹤六個月，並無角膜潰瘍復發，且視力皆獲得改善。結論：類風濕性關節炎病患產生之角膜潰瘍容易導致快速角質溶解、角膜穿孔，並造成視力喪失，因此這類病患需作積極的治療。當週邊角膜穿孔範圍較大，並且無法獲得角膜捐贈時，鞏膜移植及結膜瓣是有效且可以選擇得手術方法。當角膜穿孔範圍較小時，治療性隱形眼鏡是不錯的方法。而羊膜移植能促進角膜溶蝕及穿孔達到穩定而快速的重建。

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並列摘要

Purpose: To present our experience of successful management of rheumatoid corneal melt and perforation with different strategies. Method: Case reports Results: Case 1: A 77-year-old man with rheumatoid arthritis (RA) presented large size paracentral corneal melt and perforation following pterygium excision. He underwent an emergency scleral patch graft with conjunctival flap and visual acuity improved from counting finger to 6/30 after 6 months follow up. Case 2: A 53-year-old woman presented peripheral ulcerative keratitis with small size perforation and RA was diagnosed at the same time. She was successfully treated with therapeutic contact lens (TCL) insertion. Case 3: A 70-year-old woman with RA presented paracentral corneal melt and perforation. Corneal reepithelialization was achieved within one week by emergent amniotic membrane transplantation (AMT) and therapeutic contact lens coverage. Conclusion: RA-associated corneal melting often has a poor visual outcome and may lead to corneal perforation and should be treated more aggressively. The scleral patch graft with conjunctival flap offers an effective treatment for large peripheral corneal perforation. The TCL is an alternative good choice for small corneal perforation. The AMT promotes a stable and rapid reconstruction of corneal perforations.

並列關鍵字

rheumatoid arthritis ； corneal melt ； rheumatoid corneal perforation

國際替代計量

Management of Corneal Melting Associated with Rheumatoid Arthritis-3 Cases Reports

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