Marginal Corneal Ulcer after Cataract Surgery in Patient with Rheumatoid Arthritis

Marginal corneal ulcer following routine cataract surgery is uncommon. We report a case with this unusual condition. A 67-year-old female with longstanding rheumatoid arthritis underwent an uncomplicated extracapsular cataract extraction with posterior chamber intraocular lens implantation of her right eye. A crescent-shaped marginal corneal ulcer near the sclerocorneal incision site was noted at 4 months postoperatively. Reduced of tear secretion was also found in the right eye. Aerobic and anaerobic cultures of the corneal ulcer for bacteria were negative. Gram-stained scraping from the corneal ulcer showed polymorphonuclear leukocytes (PMNs). The patient was treated with artificial tears and topical broad spectrum antibiotics. The corneal melting ceased and four months later stromal regeneration occurred. In summary, intensive treatment of keratoconjunctivitis sicca should be instituted first, and frequent blinking can be encouraged. Topical antibiotics are used to minimize the risk of superinfection of the ulcer, and topical corticosteroid therapy should be minimized or avoided. If the above treatments failed, immunosuppressive agents and surgical intervention should be considered.