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Corneal perforation from peripheral ulcerative keratopathy in patients with rheumatoid arthritis: epidemiological findings of the British Ophthalmological Surveillance Unit
  1. Hannah Mary Timlin1,
  2. Hildegard Nikki Hall1,
  3. Barny Foot2,
  4. Peter Koay1
  1. 1 Ophthalmology Department, Princess Alexandra Eye Pavilion, Edinburgh, UK
  2. 2 Royal College of Ophthalmologists, London, UK
  1. Correspondence to Dr Hannah Mary Timlin, Princess Alexandra Eye Pavilion, Edinburgh EH3 9HA, UK; hannahtimlin{at}


Background/Aims This study quantifies the threat to vision and the survival in patients presenting with peripheral ulcerative keratopathy (PUK) corneal perforation associated with rheumatoid arthritis (RA) in the UK.

Methods New cases of corneal perforation from PUK in patients with RA were prospectively collected from the UK via the British Ophthalmological Surveillance Unit from July 2012 to June 2014. An initial questionnaire collected data on presentation and the first 2 weeks’ management, and a follow-up questionnaire collected 1-year data on ocular morbidity and mortality.

Results 30 eyes of 28 patients were identified over 2 years, estimating a UK incidence of 0.234/million/year. 20/27 (74%) were female, with a median age of 68 years (range 41–84). The most common initial management was cyanoacrylate glue with a bandage contact lens, oral steroids, topical and oral antibiotics, and lubricants. Long-term management included corneal grafting in 12/20 (60%) eyes of patients living at 1 year. The 1-year all-cause mortality was 6/25 (24%), which increased to 1/2 (50%) if both eyes had perforated. In the remaining patients alive at 1-year follow-up, there was a 13/20 (65%) poor visual outcome of less than or equal to counting fingers. 8/25 (40%) patients had bilateral PUK, with 2/25 (8%) having bilateral perforation. 5/19 (26%) patients alive at 1-year follow-up were eligible for sight impairment registration.

Conclusion This study highlights the serious ocular morbidity and high mortality associated with corneal perforation from PUK in patients with RA despite treatment. The mortality doubled if both eyes perforated, which should serve as a harbinger of impending serious medical problems.

  • cornea
  • ocular surface
  • epidemiology

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  • Contributors Conception or design of the work: HMT, BF, PK. Data collection: HMT, HNH. Data analysis and interpretation: HMT, HNH. Drafting the article: HMT. Critical revision of the article: HMT, HNH, BF, PK. Final approval of the version to be published: HMT, HNH, BF, PK.

  • Funding This work was supported by the Royal College of Ophthalmologists Ross Award Bursary.

  • Competing interests None declared.

  • Ethics approval NHS Lothian provided full REC support. Ethical approval was sought but deemed not required due to the observational nature and absence of patient identifiable data collected.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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