Peripheral Ulcerative Keratitis

Peripheral Ulcerative Keratitis presents with a crescent shaped area of stromal thinning and ulceration of the cornea with an overlying epithelial defect adjacent to the corneal stroma.

It can be associated with an underlying autoimmune disorder. The most common underlying disorders are rheumatoid arthritis, polyarteritis nodosa, inflammatory bowel disease, lupus, relapsing polychrondritis, progressive systemic fibrosis, granulomatosis with polyangiiitis, Churg-Strauss, or microscopic polyangiitis.

Treatment is lubrication, topical antibiotics to prevent a secondary infection, and systemic immunosupression with oral steroids. Cyanoacrylate glue can help in cases of impending perforation. AMT has recently been described to aid in reducing corneal melting in PUK and Mooren's Ulcers.

The first image is an AS-OCT image of a patient with Peripheral Ulcerative Keratitis with 189 microns of residual stroma remaining.  He was then treated with dehydrated  Amniotic Membrane Transplant (AMT).  The amniotic membrane was folded in half and placed under a bandage contact lens.  Several days later it had worked it’s way into the area of stromal thinning, and it has folded on itself multiple times like an accordion

The folded AMT subsequently became incorporated and allowed for epithelialization over the area of thinning. The second AS-OCT image shows 352 microns of AMG incorporated over 131 microns of cornea.

Since that point, his pain and corneal and conjunctival inflammation has resolved and his right eye looks much better.