Clinical Outcomes in Peripheral Ulcerative Keratitis

PURPOSE: To evaluate clinical and treatment outcomes in patients with peripheral ulcerative keratitis (PUK). DESIGN: Retrospective, case series SUBJECTS: Patients diagnosed with PUK at the Wilmer Eye Institute between January 2003 and October 2022. METHODS: Data collected included demographics, presence of systemic disease, disease laterality, duration of disease, PUK activity, presence of corneal perforation, and treatments. Outcomes of interest included: disease control, corticosteroid-sparing success, corticosteroid-discontinuation success, sustained drug-free remission, disease reactivation, occurrence of perforation, and need for surgery. RESULTS: Fifty-seven patients with PUK were identified. The median age was 53 years, with 46% of patients being Black. Most patients (56%) had an associated systemic diagnosis. The median duration of symptoms prior to presentation was 3 months and 42% of patients presented with bilateral disease. Of the 81 affected eyes, 7 had perforated prior to presentation. During a median follow-up of 3 years, 76% of patients received oral prednisone and 80% received at least 1 immunosuppressive drug. Disease control was achieved in all patients within a median of 1.3 months. The rates of corticosteroid-sparing success and corticosteroid discontinuation were 0.44 per patient-year (/PY) and 0.27/PY, respectively. Sustained drug-free remission was achieved in only 6% of patients. During follow-up, the rate of corneal perforation was 0.009/EY. The rate of disease reactivation was 0.07/EY, with a median time to reactivation of ∼2 years. CONCLUSIONS: Over a moderate amount of follow-up, systemic therapy achieved disease control, corticosteroid-sparing and corticosteroid discontinuation. However, sustained drug-free remission was infrequent in our cohort.