Demographic Pattern, Risk Factors and Management of PUK in Bangladeshi Patients

Background: Peripheral Ulcerative Keratitis (PUK) is a severe, vision-threatening condition characterized by progressive corneal thinning, ulceration, and inflammation. In Bangladesh, PUK is commonly associated with infections, autoimmune disorders, and Mooren’s ulcer, with microbial infections being the leading cause. Limited access to specialized ophthalmic care often results in delayed diagnosis and treatment, increasing the risk of complications. Management strategies include medical therapy with antibiotics, corticosteroids, and immunosuppressants, while severe cases require surgical intervention. Understanding the pattern and treatment outcomes of PUK in Bangladeshi patients is crucial for improving early detection, optimizing management strategies, and reducing the burden of vision loss.

Objective: In this study our main goal is to evaluate the pattern and management of peripheral ulcerative keratitis (PUK)in Bangladeshi patients.

Methods: This observational study was done in the Tertiary Hospital from January 2022 to January 2023. A total of 150 consecutive patients were included. The diagnosis PUK was made on the basis of presence of crescent-shaped destructive inflammation within at least 2 mm of limbus associated with epithelial defect, stromal inflammatory cells and possibly stromal degradation.

Results: The study found that PUK was more prevalent among males (60%) and most common in the 50–60 age group (35%). The leading cause was microbiological infection (39%), followed by Mooren’s ulcer (32%) and systemic collagen vascular disease (29%). The most frequent symptoms were foreign body sensation (39%) and blurred vision (37%). Visual acuity assessment showed variable improvement post-treatment, with some patients experiencing deterioration, particularly in severe cases. Healing time and medical treatment failure rates increased with disease severity, with 46% of severe cases requiring surgery. While surgical intervention significantly improved BCVA, medical treatment alone showed limited efficacy in advanced cases.

Conclusion: This study examines peripheral ulcerative keratitis (PUK) in Bangladeshi patients, primarily affecting middle-aged males (50-60 years). Severe cases result in significant visual impairment, with common causes including microbiological infections. Effective management requires a multidisciplinary approach, highlighting the importance of surgical intervention for improving visual outcomes in severe cases.