EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78712
April 2012 Corneal diagnoses and systemic disease February 2011 EW FEATURE 37 PUK and systemic autoimmune disease by Michelle Dalton EyeWorld Contributing Editor AT A GLANCE • Use "VAST CRIMES" as a guide to narrow down causes • Co-management with a rheumatol- ogist is highly recommended • Herpes simplex can be a common misdiagnosis, but throwing steroids at this issue won't resolve it and may exacerbate it • Mortality rates are increased in PUK-associated RA cases Usually considered an ocular manifestation of a systemic autoimmune disorder, peripheral ulcerative keratitis can result in devastating outcomes—including permanent loss of vision P eripheral ulcerative kerati- tis (PUK) is typically associated with poorly managed systemic condi- tions such as rheumatoid arthritis (RA accounts for almost one-third of non-infectious PUK), among others. What can cause it? "VAST CRIMES," said Vincent P. de Luise, M.D., assistant clinical professor of ophthalmology, Yale University School of Medicine, New Haven, Conn. PUK can be caused by "viral, autoimmune, Staphylococcal marginal, Terrien's/furrow degenera- tion, contact lenses, rosacea, infec- tions beyond viral—such as bacterial, syphilis, Lyme disease, or tuberculosis—Mooren's ulcer, exci- sional cases—because tumors can mimic—or sclerokeratitis," he said. "It's a useful mnemonic to help run down the list of potential causes." In PUK, the inflammation usu- ally involves the peripheral cornea (as its name suggests), but can also lead to both peripheral and more central corneal melting and perfora- tion if the thinning progresses. "Almost all the cases I see that are referrals have 3-4 clock hours and are at least 50% thinned," said Jennifer E. Thorne, M.D., chief of the ocular immunology division, Whether you're just beginning or experienced in cataract and refractive surgery, ASCRS is the professional society that's right for every stage of your career. Young Ophthalmologists & Residents When you're the newest member of the team, things can be a little overwhelming. ASCRS can help with the transition. Our monthly Journal of Cataract and Refractive Surgery, Annual Symposium, and online educational initiatives work to continuously augment your formal training. Through them you'll meet like-minded young ophthalmologists facing similar challenges and concerns, along with those who've successfully navigated the waters and can provide the guidance to answer your clinical, financial, and practice management questions. For young practitioners, ASCRS is where the anterior segment ophthalmology community comes together. ASCRS offers U.S. residents and fellows an unmatched opportunity to experience anterior segment ophthalmology beyond your training program—all at no cost! Resident and fellow membership, which includes the Annual Symposium, is free during your training. ASCRS makes it easy to gain real-world experience and education with no added cost. Join ASCRS today! The Society for Surgeons AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 4000 Legato Road, Suite 700, Fairfax, VA 22033 • 703-591-2220 • www.ASCRS.org An ASCRS Membership For every stage of your career and associate professor of ophthal- mology and epidemiology, Wilmer Eye Institute, Johns Hopkins Univer- sity, Baltimore. "They were referred in because the initial attempt to quiet the disease had failed— patients did not respond to corticos- teroids and the disease is progress- ing." Her advice to anyone unlikely to be treating or uncomfortable treating PUK—"refer it to a cornea or continued on page 38