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Practical Guide to Immunomodulatory Agents

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Peripheral Ulcerative Keratitis

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

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Abstract

Peripheral ulcerative keratitis treatment requires a thorough knowledge of modern immunomodulatory therapeutic agents. Although systemic corticosteroids at high doses can rapidly reduce ocular inflammation, many cases of peripheral ulcerative keratitis and necrotizing scleritis, are poorly or minimally responsive to corticosteroid therapy alone. The presence of macroscopic peripheral ulcerative keratitis especially in the presence of underlying systemic vasculitis is an absolute indication for the use of steroid sparing immunomodulatory therapeutic agents. Hence, treatment is initiated simultaneously with high-dose systemic corticosteroids combined with systemic immunomodulatory therapeutic agents, usually alkylating agents. However, antimetabolites, calcineurin inhibitors, and biologic agents such as infliximab and adalimumab can also be useful in the treatment of these complex immune-mediated ocular diseases. Because peripheral ulcerative keratitis especially in the presence of necrotizing scleritis is associated with significant risk of mortality, initiation of systemic immunomodulatory therapy can be not only sight-saving but life-saving, as well.

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Author information

Authors and Affiliations

  1. Associated Vitreoretinal and Uveitis Consultants, Indianapolis, IN, USA

    Ramana S. Moorthy

  2. Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA

    Ramana S. Moorthy & Shailaja Valluri

  3. Richard L. Roudebush VAMC, Indianapolis, IN, USA

    Shailaja Valluri

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  1. Ramana S. Moorthy
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  2. Shailaja Valluri
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Correspondence to Ramana S. Moorthy .

Editor information

Editors and Affiliations

  1. Department of Cornea and Refractive Services, Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, Delhi, India

    Radhika Tandon

  2. Department of Ophthalmology, Clinical Ophthalmology, Miami VAMC, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA

    Anat Galor

  3. Clinical Trial Center, L V Prasad Eye Institute, Hyderabad, India

    Virender Singh Sangwan

  4. Department of Ophthalmology, National University Hospital, Singapore, Singapore and, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Manotosh Ray

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Ramana S. Moorthy and Shailaja Valluri declare that they have no conflict of interest. No human or animal studies were carried out by the authors for this article.

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Moorthy, R.S., Valluri, S. (2017). Practical Guide to Immunomodulatory Agents. In: Tandon, R., Galor, A., Sangwan, V., Ray, M. (eds) Peripheral Ulcerative Keratitis. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-50404-9_12

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  • DOI: https://doi.org/10.1007/978-3-319-50404-9_12

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