Conjunctival Resection for the Treatment of the Rheumatoid Corneal Ulceration

Conjunctival resection is an effective therapeutic modality for the treatment of a marginal furrow associated with rheumatoid arthritis. Rapid reepithelialization was observed following this procedure for the treatment of five such stromal ulcers that occurred in three rheumatoid patients. Keratoconjunctivitis sicca was diagnosed in two of these patients. In four of five ulcers, minimal healing resulted from a prior trial of patching. Conjunctival resection was performed as the primary therapeutic procedure in one case in which perforation seemed possible. A literature review uncovered an additional nine such ulcers in six rheumatoid patients treated by conjunctival resection. In each case corneal healing was observed soon after the procedure. No recurrences were reported on 4- to 24-month follow-ups. This procedure has proven to be effective in each of our rheumatoid corneal ulcers and in each of the case reports in the literature. It would appear to work more reliably than subconjunctival heparin, topical anticollagenases, or immunosuppression. Conjunctival resection is a simple minor room procedure performed under topical anesthesia. It carries minimal risk for the patient. The early use of this technique for rheumatoid stromal ulcers is advocated, especially when the area of ulceration is extensive, when the stromal loss is progressive, and when stromal reserve is minimal. Early conjunctival resection can shorten the hospital stay, and in more severe cases could prevent perforation. Based on successful treatment in a combined total of 14 peripheral rheumatoid corneal ulcerations, the authors believe Conjunctival resection should have a more prominent place in the treatment of this condition.