TNF-α Inhibitors for the Management of Intractable Corneal Melt: Report of Three Cases and Review of the Literature. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Utine, Canan Asli; Birlik, Merih; Özizmirliler, Denizcan; Karakaş, Ali; Akbulut, Betül; Durak, Ismet
• Is Part Of: Eye & contact lens. Volume 47:Issue 6(2021)
• Publication Date: 2021-06
• Subjects: Corneal melting -- Infliximab -- TNF-α inhibitor; Contact lenses -- Periodicals; Intraocular lenses -- Periodicals; Orthokeratology -- Periodicals; Anterior segment (Eye) -- Diseases -- Periodicals; 617.7523
• DOI: 10.1097/ICL.0000000000000770
• Languages: English
• ISSNs: 1542-2321

Abstract

Abstract : Objective: To report three consecutive cases with noninfectious corneal melting, whose disease progression could only be halted with tumor necrosis-α (TNF-α) inhibitor infusion, with a review of the relevant literature. Materials and methods: Patients with toxic epidermal necrolysis, severe alkaline burn, and Sjögren syndrome had experienced severe corneal melting following penetrating keratoplasty, Boston type 1 keratoprosthesis implantation or spontaneously, respectively. Topical autologous serum eye-drops, medroxyprogesterone, and acetylcysteine formulations; frequent nonpreserved lubrication; systemic tetracyclines and vitamin-C supplements; topical and systemic steroids and steroid-sparing agents; surgical approaches including amniotic membrane transplantation, tectonic graft surgery; and tarsorraphy failed to alter the disease courses. Results: Upon consultation with the rheumatology clinic, TNF-α inhibitor infliximab (Remicade; Centocor Ortho Biotech Inc, Horsham, PA) 5 mg/kg infusion was planned for each patient. After 0-, 2-, and 6-week doses, monthly infusion at the same dose was maintained for 12 months because of severe and intractable course of their diseases. Each case showed dramatic improvements in corneal melts; and sterile vitritis in the eye with Boston keratoprosthesis responded, as well. Conclusions: Inhibiting TNF-α-mediated expression of matrix metalloproteinases responsible for collagen breakdown should be considered in refractory cases, as a means of globe salvage.