Ocular complications and mortality in peripheral ulcerative
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Peripheral ulcerative keratitis (PUK) is a rare corneal disorder characterised by progressive juxtalimbal corneal stromal thinning. Necrotising scleritis is another immune-mediated ocular condition that preferentially affects the sclera instead of the corneal stroma. A study was conducted to examine clinical characteristics of subjects with peripheral ulcerative keratitis (PUK) and necrotising scleritis.

Overall, 27 eyes presented with PUK, 26 with necrotising scleritis, and 22 with corneal infiltrates associated with active scleritis. Recurrence occurred in 23 eyes (44.2%) 10 eyes experiencing PUK or necrotising scleritis; 13 eyes with non necrotising scleritis. Perforation occurred in six eyes (11.5%). Moderate vision loss occurred in 10 eyes (19.2%) and severe loss in six eyes (11.5%). Five subjects (12.2%) were deceased by study conclusion, of whom four were not on immunomodulatory therapy (IMT). A marked difference in estimated survival was observed with IMT, with mean estimated survival of 10.7 years without treatment, compared to 24.7 years with IMT.

Research supports the link between systemic immunosuppression and significantly reduced mortality in those patients with necrotising scleritis and PUK.Also confirmed that these conditions, although rare, can have serious associated ocular morbidity, some of which is irreversible. Trends in recurrence suggest most recurrence in the first 2 years and late recurrence being an uncommon feature. Looking at all of these factors, it recommends early initiation of systemic immunosuppression in patients presenting with necrotising scleritis and PUK, to reduce serious ocular complications, and to reduce associated mortality.

Source: https://onlinelibrary.wiley.com/doi/10.1111/ceo.13709