Peripheral Ulcerative Keratitis Outcomes Improved With Immunomodulatory Therapy, Doxycycline

Corneal ulcer
MODEL RELEASED. Corneal ulcer. Close-up of the right eye of a 72-year-old man with a dendritic corneal ulcer (cloudy area). The cornea is the transparent front part of the eye. A corneal ulcer (ulcerative keratitis) is a form of inflammation of the cornea. It is usually due to some form of infection.
Researchers conduct a review of patients with peripheral ulcerative keratitis to determine presenting characteristics and determine response to treatment.

Systemic immunomodulatory therapy and doxycycline help to treat peripheral ulcerative keratitis (PUK) and improve visual outcomes, according to research published in Eye & Contact Lens.

Researchers reviewed data from 22 patients (mean age, 69.81±14.54 years; 26 eyes) with PUK who presented to ophthalmology tertiary referral centers between 2015 and January 2021. Follow-up was a mean 577.73 days.

Among the cohort, 13 eyes (50.0%) had systemic autoimmune disease, 9 had rheumatoid arthritis, 5 had preexisting rheumatoid arthritis, and 1 eye had syphilis serology. Nearly four-fifths of patients underwent inpatient treatment, with a stay of 7.23±7.34 days. A total of 17 patients received topical antibiotics to treat potential infectious keratitis while 8 patients received topical steroid treatment. Fifteen patients received oral doxycycline while 18 patients received oral prednisone.

Patients with bilateral involvement were more likely to have better best-corrected visual acuity (BCVA) at baseline compared with those with unilateral involvement (0.28±0.30 vs 0.78±0.71 logarithm of the minimum angle of resolution (logMAR); P =.05). However, patients with bilateral involvement tended to experience a significant decrease in BCVA (+0.26±0.25 logMAR; P =.05), while those with unilateral involvement did not (-0.10±0.20 logMAR; P =.28).

BCVA improved among patients who received immunomodulatory therapy (-0.10±0.29 with vs. +0.10±0.35 without) or doxycycline (-.08±0.09 with vs. +0.22±0.49 without), but this value failed to achieve statistical significance.

Of 5 patients who experienced corneal perforation, 4 were treated with corneal transplantation. Four of the patients presented with perforation and 2 patients were treated with deep anterior lamellar keratoplasty (DALK).

“[PUK] requires stepwise, intensive, local and systemic management,” according to the researchers. “An overall excellent outcome was observed for patients across Queensland, with good visual outcomes and a low rate of ocular morbidity. We suggest that localized ocular management with the exclusion of infection, intensive lubrication, topical antimicrobials, and topical steroids alongside doxycycline, early immunosuppression, and the use of immunomodulatory therapies are necessary.”

Study limitations include a small sample size and diversity of immunomodulatory therapies. 


Li Y, McKelvie J, McLintock C. Visual outcomes of patients with peripheral ulcerative keratitis and the effect of immunosuppression—a 6-year experience in Queensland, Australia. Eye Contact Lens. 2022;48(7):283-288. doi:10.1097/ICL.0000000000000906