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Rourke and Murphy, Int J Ophthalmic Pathol 2015, 4:3
International Journal of
Ophthalmic Pathology
Clinical Image a SciTechnol journal

A Description of the
Pathological Features of
Rheumatoid Corneal Melt
Michal O Rourke* and Prof Conor Murphy

A 34 year old woman with a 20 year history of rheumatoid Figure 1: Anterior segment photograph showing a 3mm descemetocele.
arthritis (RA) presented with a 1 day history of blurred vision in her
right eye. Three years earlier she had developed a corneal melt, which
had stabilised with a combination of lubricants, topical cyclosporine
and a short course of oral prednisolone, and was regularly monitored.
Her arthritis had been quiescent for several years on etanercept.
Examination of the right cornea revealed a 3 mm descemetocele an
area of corneal stromal melting characterised by total loss of corneal
stroma down to Descemets membrane, the basement membrane of
the corneal endothelium that was leaking aqueous humour and
causing shallowing of the anterior chamber. This is represented in the
anterior segment photo (Figure 1) as the dark circular area within
the area of corneal scarring. The corneal epithelium was fully intact
and the eye was white and quiet. After an attempt at gluing of the
perforation, she underwent a tectonic corneal transplant and was Figure 2: Corneal histology of the rheumatoid keratolysis shows
complete absence of stroma with only epithelium and Descemets
prescribed tacrolimus to reduce the risk of allograft rejection. After membrane remaining. The adjacent stroma is highly disorganised.
3 uneventful years, the corneal transplant was clear, her unaided
visual acuity was 20/30 and the tacrolimus was discontinued. On
histological examination, the descemetocele was characterised by
a fully intact corneal epithelium and Descemets membrane with 1. Messmer EM, Foster CS (1995) Destructive corneal and scleral disease
associated with rheumatoid arthritis. Medical and surgical management.
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thinned and disorganised and showed a mild inflammatory infiltrate.
2. Iliou C, Anthis N, Tsifetaki N, Kitsos G, Voulgari PV(2012) Clinical images:
Rheumatoid keratolysis is a rare complication of RA which Corneal melt in a woman with longstanding rheumatoid arthritis. Arthritis
Rheum 64: 253.
is typically seen in elderly patients with late stage disease [1-4].
3. Michels ML, Cobo LM, Caldwell DS, Rice JR, Haynes BF (1984) Rheumatoid
Inflammatory symptoms and signs are usually absent, as in this
arthritis and sterile corneal ulceration. Analysis of tissue immune effector cells
case where silent progressive melting of the stroma led to corneal and ocular epithelial antigens using monoclonal antibodies. Arthritis Rheum
perforation [4,5]. It has been suggested that matric metaloproteinases, 27: 606-614.
which are activated in the rheumatoid joint are also involved in 4. Squirrell DM, Winfield J, Amos RS (1999) Peripheral ulcerative keratitis
keratolysis [6] but the pathogenesis of this enigmatic condition is corneal melt and rheumatoid arthritis: a case series. Rheumatology 38:
poorly understood.
5. Malik R, Culinane AB, Tole DM, Cook SD (2006) Rheumatoid keratolysis: a
series of 40 eyes. Eur J Ophthalmol 16: 791-797.

6. Riley GP, Harrall RL, Watson PG, Cawston TE, Hazleman BL (1995)
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*Corresponding author: Michal O Rourke, Royal Victoria Eye and Ear Author Affiliation Top
Hospital, Dublin, Ireland, Tel: +353 86 306 1412; E-mail: Royal Victoria Eye and Ear Hospital, Dublin, Ireland
Received: March 19, 2015 Accepted: July 16, 2015 Published: July 22, 2015

Citation: Rourke MO, Murphy C (2015) A Description of the Pathological Features of Rheumatoid Corneal Melt Strategies. J Ophthalmic Pathol 4:3.

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