{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:24:09Z","timestamp":1787847849967,"version":"build-2784847793"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>Rheumatoid arthritis (RA) can affects many organs including the eyes. Corneal perforation in the form of peripheral ulcerative keratopathy can be debilitating and difficult to manage. A 48-year-old female with known RA presented with sudden loss of vision in her left eye, she was diagnosed with left corneal perforation secondary to severe dry eye. Penetrating keratoplasty (PKP) and punctum occlusion were done. Amniotic membrane transplant (AMT) was done 1 month later due to nonhealing epithelial defect. Her RA was clinically inactive, and no changes in her current medications were made. However, 4 months later, she presented with a second corneal perforation with melting. She had another PKP and AMT with permanent temporal tarsorrhaphy. Cyclosporine 100 mg P. O. twice daily was added, but after 5 months, she presented again with a third left corneal perforation with melting. Again, PKP and AMT with tarsorrhaphy were done, and she was started on infliximab. Since then, she had a stable graft with no further corneal perforations. In summary, patients with RA can have corneal perforations even if other signs of RA are absent. If the systemic treatment that is used to treat RA fails, one should consider using other classes of drugs, such as monoclonal antibodies (e.g., rituximab), tumor necrosis factor alpha blockers (such as infliximab or adalimumab), interleukin (IL)-1 receptor antagonists (e.g., anakinra), or IL-6 receptor antagonist (e.g., tocilizumab).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/1319-4534.310409","type":"journal-article","created":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T05:10:14Z","timestamp":1614748214000},"page":"216-217","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Recurrent and refractory corneal perforation secondary to rheumatoid arthritis treated with infliximab"],"prefix":"10.4103","volume":"34","author":[{"given":"Ahmed","family":"Al Saleh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah S.","family":"Al Saleh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmalik","family":"Al Qahtani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-16-20240830","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1093\/rheumatology\/38.12.1245","article-title":"Peripheral ulcerative keratitis 'corneal melt' and rheumatoid arthritis: a case series","volume":"38","author":"Squirrell","year":"1999","journal-title":"Rheumatology"},{"key":"R2-16-20240830","first-page":"173793","article-title":"Stabilization of bilateral progressive rheumatoid corneal melt with infliximab","volume":"2012","author":"Antao","year":"2012","journal-title":"Case Rep Ophthalmol Med"},{"key":"R3-16-20240830","doi-asserted-by":"crossref","first-page":"7298026","DOI":"10.1155\/2017\/7298026","article-title":"Peripheral ulcerative keratitis associated with autoimmune disease: Pathogenesis and treatment","volume":"2017","author":"Cao","year":"2017","journal-title":"J Ophthalmol"},{"key":"R4-16-20240830","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0049-0172(95)80019-0","article-title":"Peripheral ulcerative keratitis in the setting of rheumatoid arthritis: Treatment with immunosuppressive therapy","volume":"25","author":"Jifi-Bahlool","year":"1995","journal-title":"Semin Arthritis Rheum"},{"key":"R5-16-20240830","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1097\/01.ico.0000154391.28254.1d","article-title":"Therapy of progressive rheumatoid arthritis-associated corneal ulceration with infliximab","volume":"24","author":"Thomas","year":"2005","journal-title":"Cornea"},{"key":"R6-16-20240830","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/01.rhu.0000249766.24780.95","article-title":"Rheumatoid arthritis-associated necrotizing scleritis and peripheral ulcerative keratitis treated successfully with infliximab","volume":"12","author":"Atchia","year":"2006","journal-title":"J Clin Rheumatol"},{"key":"R7-16-20240830","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1586\/1744666X.2014.907744","article-title":"Regulation of B lymphocytes and plasma cells by innate immune mechanisms and stromal cells in rheumatoid arthritis","volume":"10","author":"Maseda","year":"2014","journal-title":"Expert Rev Clin Immunol"},{"key":"R8-16-20240830","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1097\/ICO.0b013e31826218c7","article-title":"Atypical continuous keratitis in a case of rheumatoid arthritis accompanying severe scleritis","volume":"31","author":"Hata","year":"2012","journal-title":"Cornea"}],"container-title":["Saudi Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/1319-4534.310409","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:41:19Z","timestamp":1787845279000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/1319-4534.310409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7]]},"references-count":8,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.4103\/1319-4534.310409","relation":{},"ISSN":["1319-4534"],"issn-type":[{"value":"1319-4534","type":"print"}],"subject":[],"published":{"date-parts":[[2020,7]]}}}