Spontaneous corneal perforation in a patient with unusual unilateral pellucid marginal degeneration

Pterygium combined with corneal perforation: a case report

BACKGROUND

Pterygium is a common ocular surface disease. Pterygium combined with corneal perforation is rare.

CASE PRESENTATION

A 28-year-old female patient visited our outpatient clinic due to sudden onset of blurred vision and increased tearing in her left eye. The visual acuity was 1.0 OD and intraocular pressure (IOP) of 19.5 mmHg for the right eye with no significant abnormalities found in the anterior and posterior segments. The visual acuity of her left eye was 0.06, and IOP was 6.2 mmHg. A triangular vascular membranous tissue was seen in her left eye below the nose growing into the cornea and the pupil area was not touched. Slit-lamp examination revealed a tiny round corneal perforation in 8 o'clock position of the lesion area. Hospital diagnosis was given as pterygium combined with corneal perforation. The patient was treated with levofloxacin eye drops and autologous serum-based eye drops.

CONCLUSIONS

We report a rare case of pterygium combined with corneal perforation. Perforation is a very rare complication of pterygium. This patient received proper treatment and good result was seen. This article aimed to improve clinicians' understanding of pterygium.

Surgical management of peripheral corneal thinning disorders

The peripheral corneal thinning disorders are associated with degenerative, autoimmune, or infective causes. Corneal thinning can subsequently affect the visual acuity either by inducing severe astigmatism or by progressive involvement of the central cornea. In addition to this, the integrity of the eye is at risk. Medical management is necessary to address the underlying inflammatory or infectious causes; however, most of the cases require surgical intervention for tectonic support or for visual rehabilitation in patients with severe astigmatism. Preoperative investigations help in mapping the corneal curvature and thickness, thereby facilitating planning of treatment. Routine corneal transplantation techniques do not yield good results in peripheral corneal thinning disorders. Various surgical modifications have been described to manage these challenging cases. We review the available literature on causes and management of peripheral corneal thinning disorders.

Corneal Hydrops in Pellucid Marginal Degeneration: A Case Series

PURPOSE

To report an unusual presentation of pellucid marginal degeneration (PMD) and its management by using air injection and tension sutures.

CASE REPORT

We report 2 cases with a history of acute pain and loss of vision. Examination revealed hydrops at the 6-9 o'clock meridian with Descemet's membrane detachment and tear at the same area and advanced PMD in the other eye.

DISCUSSION

Air injection with suturing to treat the hydrops in PMD and crescentic excision with lamellar grafting instead of lamellar keratoplasty lead to better results than conservative management.

CONCLUSION

Corneal hydrops and perforation in patients with PMD is a rare presentation and can be managed by tension sutures and air injection.

Spontaneous corneal perforation associated with atopic keratoconjunctivitis: a case series and literature review

PURPOSE

To describe spontaneous corneal perforations in patients with atopic keratoconjunctivitis.

METHODS

Records of patients with atopic keratoconjunctivitis and spontaneous corneal perforation seen by the authors were reviewed. A literature search of corneal complications in atopic keratoconjunctivitis and predisposing factors for spontaneous corneal perforations in corneal ectasias was undertaken.

RESULTS

Three patients with seven incidents of corneal perforation were identified and presented. Corneal thinning and keratoconus are observed at a higher rate in patients with atopic keratoconjunctivitis, and severe ocular allergy has been reported as a risk factor for corneal hydrops.

CONCLUSIONS

Atopic keratoconjunctivitis appears to be a risk factor for spontaneous sterile corneal perforation. Corneal thinning and keratoconus in addition to inflammatory changes of the cornea in these patients probably predispose to the corneal melt in these perforations. A close observation of the fellow eye of affected patients is important and systemic immunosuppressive therapy should be considered.

Pellucid marginal degeneration and bilateral corneal perforation: case report and review of the literature

PURPOSE

To review corneal perforation cases in pellucid marginal degeneration and report a case of bilateral spontaneous perforation at presentation in rigid gas permeable contact lens wear and pellucid marginal degeneration.

METHODS

Case report and literature review.

RESULTS

The presentation, clinical course, surgical intervention, pathologic analysis, and postoperative outcome of a case of bilateral spontaneous corneal perforation in pellucid marginal degeneration are detailed. All spontaneous corneal perforation cases associated with pellucid marginal degeneration are reviewed.

CONCLUSIONS

Pellucid marginal degeneration can lead to spontaneous corneal perforation resulting in the need for urgent therapeutic intervention. A potential for severe ocular morbidity should be considered in all patients with this disorder despite a seemingly stable disease and appropriate gas permeable contact lens wear. Unilateral perforation cases should be watched closely for development of complications in the fellow eye.

Corneal Perforation Associated With Pellucid Marginal Degeneration and Treatment With Crescentic Lamellar Keratoplasty

PURPOSE

To describe 2 cases of corneal perforation associated with pellucid marginal degeneration (PMD) and subsequent successful management with crescentic lamellar keratoplasty.

METHODS

Two cases are discussed along with the relevant literature.

RESULTS

Both patients presented with spontaneous corneal perforations and associated features consistent with PMD. In both cases, there was fellow eye evidence of PMD, and 1 of the patients was already known to our unit with this diagnosis. Initial conservative measures were unsuccessful, and both patients underwent crescentic lamellar keratoplasty as the definitive surgical management with a good visual outcome.

CONCLUSIONS

Crescentic lamellar keratoplasty is an effective technique for the management of this rare complication of PMD.

Successful conservative management of hydrops with perforation in pellucid marginal degeneration

CASE REPORT

Hydrops with perforation in the setting of pellucid marginal degeneration is a rare complication that is generally treated surgically. We report the first case of successful nonsurgical management using only a bandage contact lens.

COMMENTS

Hydrops with perforation in one eye is a risk factor for a similar event occurring in the other eye. Initial conservative management with a bandage contact lens should be considered to avoid the risk of surgery. After resolution of hydrops, flattening of the cornea and reduced astigmatism is also a potential benefit.

Spontaneous corneal hydrops and perforation in keratoconus and pellucid marginal degeneration

PURPOSE

To report two cases of pellucid marginal degeneration and one case of keratoconus associated with spontaneous corneal hydrops leading either to perforation or imminent perforation, requiring urgent keratoplasty.

METHOD

Retrospective interventional case series of three patients with noninflammatory peripheral corneal degenerations. A retrospective review was done of the clinical courses, surgical interventions, and pathologic specimens, development of spontaneous hydrops, perforation, need for surgical intervention, and final visual outcome.

RESULTS

Two patients with pellucid marginal degeneration and one with keratoconus developed spontaneous hydrops followed by aqueous leakage through markedly thinned anterior stroma. In one case, the leak site was successfully sealed after three separate applications of tissue adhesive, although the remaining two cases required penetrating keratoplasty.

CONCLUSIONS

These cases document the very unusual occurrence of corneal hydrops leading to spontaneous corneal perforation in patients with keratoconus and pellucid marginal degeneration.