Peripheral Ulcerative Keratitis: Management
Purpose of Review: This study aimed to discuss an updated, evidence-supported, stepwise approach to the diagnosis and treatment of peripheral ulcerative keratitis (PUK). Recent Findings: PUK conventionally describes a rapidly progressive, crescent-shaped, peripheral, and inflammatory corneal melt. Undertreated PUK may lead to vision loss and premature mortality. A comprehensive approach includes diagnosis, short-term treatment, long-term treatment, and surgical considerations. Diagnosis is based on clinical findings. Next, the clinician should pursue an underlying etiology with a meticulous workup, including careful consideration of microbial keratitis. Common causes are rheumatoid arthritis, microbial keratitis, systemic necrotizing vasculitis (such as granulomatosis with polyangiitis), and collagen vascular disease (such as systemic lupus erythematosus). For short-term management of noninfectious PUK, therapy involves intensive anti-inflammatory therapy with corticosteroids. Adjunctive therapies such as conjunctival resection, amnionic membrane transplantation, and topical cyclosporine are also discussed. Recurrence commonly occurs, sometimes months to years later. Recurrence is a major source of premature vision loss. Additionally, smoldering disease activity seems to confer a risk of early mortality. Therefore, we recommend starting or escalating immunomodulatory therapy patients in most patients with sight-threatening, steroid-responsive, noninfectious PUK, especially (but not limited to) those with systemic features or a corneal graft. Summary: PUK is a sight-threatening condition that requires a short-term and long-term view of the disease. Multidisciplinary collaboration with other physicians is crucial to achieve optimal outcomes.
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