DESTRUCTIVE CORNEAL AND SCLERAL DISEASE-ASSOCIATED WITH RHEUMATOID-ARTHRITIS - MEDICAL AND SURGICAL-MANAGEMENT

The onset of necrotizing scleritis (NS) and peripheral ulcerative kera titis (PUK) in the clinical course of rheumatoid arthritis (RA) may re flect the presence of systemic, potentially lethal vasculitis. In an e ffort to better characterize this subset of patients with severe RA-as sociated corneal and/or scleral inflammation and to analyze the effica cy of therapy, we reviewed our experience in the medical and surgical management of 16 tertiary referral cases (25 eyes) unresponsive to agg ressive conventional therapy with topical and systemic steroids as wel l as with systemic nonsteroidal drugs. Cytotoxic immunosuppressive the rapy was instituted in all patients with NS and/or PUK. Cyclophosphami de and methotrexate were the most successful agents used. Cytotoxic im munosuppressive drugs in conjunction with early aggressive surgical tr eatment halted the relentlessly progressive inflammation and preserved the integrity of the globe in 92% of eyes. Visual acuity could be sta bilized or improved in 83% of patients with NS and in 68% of patients with PUK.