Rheumatoid keratolysis a silent complication associated with Rheumatoid arthritis

A 34 year old women suffering from rheumatoid arthritis since 20 years had a complaint of blurred vision in right as she had a problem of corneal melting.  It has been stabilised bytreatment followed by regular monitoring that arthritis was in-active on etanercept.But right cornea revealed 3mm descemetocle, later tectonic corneal transplantation was done and was prescribed tacrolimus. The histological examinations done after three years was characterised by complete loss of corneal stroma due to rheumatoid keratolysis. It has been indicated that metalloproteinase are active in RA are involved in Keratolysis.

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Prevention of Infectious Keratitis after Corneal Refractive Surgery

The real prevalence of infectious keratitis after refractive surgery is difficult to determine, due to its rarity. In 2010 we reported a prevalence of 72 cases in 204,586 LASIKprocedures, a 0.035%. Other series had shown prevalence’s ranging from 0.034 to 0.180%, but ours was, by far, the largest series published to date. 

As happens in LASIK, the prevalence of infections after SA is rare and it is difficult to determine if the series does not comprise a large number of operated eyes. In 2011 we published our prevalence in SA. We found 39 cases in 18,651 procedures, a 0.200%. Therefore, in our institution, corneal infections were five times more prevalent after SA than after LASIK.

There is much consensus about the standard treatment of corneal infections after corneal refractive surgery. According to the ASCRS White Paper aggressive management with early flap lifting, scraping, culture, and irrigation with antibiotics should be followed. 

Is it safe to use BAK containing eyewashes?

Usage of eyewashes has increased drastically for healthy eyes due pollinosis and increase usage of contact lenses. Recently they summarised that usage of eye washes containingpreservative BAK showed some disorders such as, collapse of the mucin layer in cornea and epithelium disorders. They also stated that BAK free ophthalmic solutions are used for the treatment of glaucoma, dry eyes and eye allergies. Eye washes lacking BAK showed reduction in corneal disorder.

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