Unique Surgical Strategy of Annular Sclerocorneal Keratoplasty to Manage a Case of Peripheral Ulcerative Keratitis with 360° Thinning and Perforation

Peripheral ulcerative keratitis (PUK) is a disorder affecting the peripheral cornea, characterized by stromal lysis and thinning. The underlying cause can be local infection or noninfectious causes like collagen vascular diseases or vasculitis. Systemic conditions can often have a bilateral presentation. We are reporting a case with bilateral PUK. The right eye had 360° peripheral corneal thinning and perforation, which was urgently managed surgically with an annular keratoplasty using the peripheral sclerocorneal rim of the donor graft, retaining the central cornea of the patient. In the left eye, conjunctival resection was done. Immunological evaluation revealed the patient to be positive for rheumatoid factor. A thorough evaluation is necessary as ophthalmic disease might be the initial presentation of an underlying systemic disorder. This case intends to highlight the unique surgical technique used for management as well as the importance of having a high index of suspicion for autoimmune diseases in such cases.