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Pellegrini F, Vincigiuerra A, Maria AD. Spontaneous bilateral corneal perforation in ocular Rosacea. Eur J Ophthalmol 2024; 34:NP5-NP7. [PMID: 37915114 DOI: 10.1177/11206721231212087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE To report a rare case of a 19-year-old girl who presented with spontaneous bilateral corneal perforation in a setting of ocular rosacea. METHODS Ocular rosacea was diagnosed and treated with doxycycline. Cyanoacrylate glue was applied to treat corneal perforations. RESULTS At six months follow up there is good healing, visual acuity has improved, anterior chamber is deep with no Seidel. CONCLUSIONS Rosacea is a multifactorial disease with an unclear pathophysiology. The ocular manifestations of rosacea (ocular rosacea) may occur without skin involvement, are not specific and can range from mild blepharitis to sight-threatening conditions. This case shows how ocular rosacea can lead to serious vision-threatening complications with mild symptoms. Cyanoacrylate glue and systemic antibiotic treatment are effective treatments.
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Bonte AS, Ni Dhubhghaill S, Leysen I, Koppen C. Severe Corneal Damage After Minor Eyelid Surgery: A Case Series. Eye Contact Lens 2024; 50:194-197. [PMID: 38386977 DOI: 10.1097/icl.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To present three cases of serious corneal complications after seemingly minor and uncomplicated eyelid surgery. METHODS These cases emphasize the real-world risk of corneal damage after oculoplastic surgery. RESULTS The first case is a 46-year-old man referred to our department with a corneal perforation after bilateral blepharoplasty of both upper and lower eyelids. The second case concerns a 51-year-old woman who suffered an accidental coagulation of the cornea during the removal of upper eyelid papillomas, and the third case is a 55-year-old woman who had severe corneal thinning accompanied by visual loss after an upper lid blepharoplasty. All patients were stabilized without the need for corneal transplantation, although there were significant corneal scars and sequelae. CONCLUSIONS Although complications after esthetic oculoplastic surgery are rare, the reported cases show that corneal damage can have a major impact on the patient's vision and quality of life. Strategies such as the use of a corneal shield can be used to mitigate these risks, but their use is debated. Nevertheless, diligent postoperative care is paramount. At the first postoperative visit, a basic visual acuity measurement should be performed. In cases where reduced vision is reported, particularly when accompanied by pain, patients should be urgently referred for specialized eye care.
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Affiliation(s)
- Anne-Sophie Bonte
- Department of Ophthalmology (A.-S.B., N.D.S., I.L., C.K.), Antwerp University Hospital, Edegem, Belgium; and Faculty of Health Sciences (A.-S.B., N.D.S., I.L., C.K.), University of Antwerp, Edegem, Belgium
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Jing X, Congxin L, Xiaoyan Z, Yue Y, Jiao L, Peipei Z, Yirong W, Ying W, Hongsheng B. Interface fluid syndrome caused by the corneal perforation injury after small incision lenticule extraction: a case report. BMC Ophthalmol 2024; 24:117. [PMID: 38481187 PMCID: PMC10938799 DOI: 10.1186/s12886-024-03339-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND To report a case of interface fluid syndrome (IFS) following traumatic corneal perforation repair after small incision lenticule extraction (SMILE). CASE PRESENTATION A 23-year-old woman, with a past history of SMILE, was struck in the left eye with a barbecue prod and subsequently underwent corneal perforation repair at local hospital. Primary wound repaired with a single 10 - 0 nylon suture at the area of leakage. After the surgery, her best corrected visual acuity (BCVA) was 20/30. Four days later, she presented at our hospital with blurred vision, and interface fluid syndrome (IFS) was diagnosed. Intraoperative optical coherence tomography (iOCT) was used to guide the resuturing of the corneal perforation in the left eye, followed by anterior chamber gas injection. At the first postoperative month, the BCVA was 20/25. The corneal cap adhered closely to the stroma, the surface became smooth. CONCLUSIONS This case illustrates that any corneal perforation following lamellar surgery, including SMILE, may lead to IFS. It is crucial to consider the depth of corneal perforation, and intraoperative optical coherence tomography (iOCT) plays a unique role in the repair procedure.
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Affiliation(s)
- Xu Jing
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China
| | - Li Congxin
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China
| | - Zhang Xiaoyan
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China
| | - Yuan Yue
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China
| | - Li Jiao
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China
| | - Zu Peipei
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China
| | - Wang Yirong
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China
| | - Wen Ying
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China.
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Shandong Academy of Eye Disease Prevention and Therapy, No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China.
| | - Bi Hongsheng
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine (TCM), No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China.
- Shandong Provincial Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Diseases, Shandong Academy of Eye Disease Prevention and Therapy, No. 48#, Yingxiongshan Road, 250002, Jinan, P. R. China.
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Lacorzana J, Hong SC, Georges P, Petsoglou C. Patch endothelial keratoplasty for corneal perforations secondary to ocular surface disease: case series. Graefes Arch Clin Exp Ophthalmol 2024; 262:519-526. [PMID: 37594511 DOI: 10.1007/s00417-023-06194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/19/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Corneal perforation is an ophthalmic emergency. The conventional management of corneal perforation can be associated with severe complications especially in patients with ocular surface disease. Endothelial keratoplasty has been suggested as an alternative surgical technique for the management of corneal perforations. We present a case series of nine patients with corneal perforation and ocular surface disease managed with secondary patch endothelial keratoplasty. METHODS This is a retrospective case series of nine patch endothelial keratoplasties performed between 2016 and 2022 at a quaternary eye hospital in Australia. The surgical technique is similar to conventional endothelial keratoplasty except descemetorhexis was not performed. RESULTS A total of 9 cases were treated during the review period. Eight of the nine cases had an improvement in visual acuity. One case failed to achieve corneal tectonic objective. CONCLUSION Patch endothelial keratoplasty is a safe secondary procedure for the management of corneal perforations in patients with ocular surface disease.
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Affiliation(s)
- Javier Lacorzana
- Department of Ophthalmology, Cornea Unit, Sydney Eye Hospital, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia
- Department of Ophthalmology, Glaucoma Unit, Birmingham and Mindland Eye Center, Birmingham, UK
| | - Sheng Chiong Hong
- Department of Ophthalmology, Cornea Unit, Sydney Eye Hospital, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia.
| | - Pierre Georges
- New South Wales Tissue Bank, New South Wales Organ and Tissue Donation Service, Sydney, Australia
| | - Constantinos Petsoglou
- Department of Ophthalmology, Cornea Unit, Sydney Eye Hospital, 8 Macquarie Street, Sydney, New South Wales, 2000, Australia
- New South Wales Tissue Bank, New South Wales Organ and Tissue Donation Service, Sydney, Australia
- Specialty of Ophthalmology, Faculty of Medicine, University of Sydney, Sydney, Australia
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Sharma A, Sharma R. Customized therapeutic deep anterior lamellar keratoplasty in perforated Mooren's ulcer: A novel technique. Indian J Ophthalmol 2024; 72:130-133. [PMID: 38131585 PMCID: PMC10841791 DOI: 10.4103/ijo.ijo_964_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/28/2023] [Accepted: 09/16/2023] [Indexed: 12/23/2023] Open
Abstract
We describe customized therapeutic deep anterior lamellar keratoplasty (DALK) for treating a perforated Mooren's ulcer. Slit-lamp biomicroscopy revealed corneal perforation (3.5 mm × 3.0 mm) with iris prolapse. The corneal melt extended from 9.0 o'clock to 4.0 o'clock. The peripheral edge of the ulcer was sloping, whereas the medial edge showed undermining. Immunological tests did not reveal any evidence of systemic autoimmune disease. In view of extensive peripheral corneal melt with large corneal perforation, the patient needed tectonic keratoplasty. The penetrating graft is not only technically demanding but also results in a poor visual outcome. We advised customized tectonic DALK. We used two different-sized trephines to obtain appropriate-sized donor tissue and avoided manual dissection. The post-surgery period was uneventful. He was prescribed topical steroids and oral methotrexate. He achieved 6/9 aided visual acuity at 4 months and maintained it until the last follow-up at 36 months.
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Affiliation(s)
- Ashok Sharma
- Cornea Centre, SCO 2463-2464, Sector 22 C, 160022, Chandigarh, India
| | - Rajan Sharma
- Cornea Centre, SCO 2463-2464, Sector 22 C, 160022, Chandigarh, India
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Wang Y, Puerkaiti H, Mu J, Gao Y. Repair of peripheral corneal perforation by autologous scleral transplantation: Case report. J Fr Ophtalmol 2023; 46:e393-e395. [PMID: 37620192 DOI: 10.1016/j.jfo.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Y Wang
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, 116, Huanghe Road, Shayibake District, Ürümqi, Xinjiang, China
| | - H Puerkaiti
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, 116, Huanghe Road, Shayibake District, Ürümqi, Xinjiang, China
| | - J Mu
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, 116, Huanghe Road, Shayibake District, Ürümqi, Xinjiang, China
| | - Y Gao
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, 116, Huanghe Road, Shayibake District, Ürümqi, Xinjiang, China.
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Jovanovic V, Nikolic L, Seiler TG, Jankov MR. Acute hydrops followed by corneal perforation five years after corneal cross-linking for keratoconus. Arq Bras Oftalmol 2023; 86:e20230059. [PMID: 35544929 DOI: 10.5935/0004-2749.20230059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/07/2021] [Indexed: 10/27/2023] Open
Abstract
We report a case of acute corneal hydrops followed by corneal perforation five years after corneal cross-linking for keratoconus. A healthy 24-year-old female patient underwent Dresden protocol cross-linking in her left eye due to advanced keratoconus. After five years of a stable cornea, she returned with epiphora, blurred vision, and a soft left eye. Acute hydrops and corneal perforation were diagnosed. There was no history of pregnancy, atopy, eye rubbing, trauma, or contact lens use. Local antibiotic and eye patching were applied. Three months after the resolution of the acute episode, she retained useful visual acuity with no need for further surgery. Although cross-linking efficiently halts keratoconus, progression can occur, leading to corneal hydrops and perforation, even in the absence of any risk factors.
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Affiliation(s)
- Vesna Jovanovic
- Faculty of Medical Dentistry, University of Belgrade, Belgrade, Serbia
- Centre for Microsurgery LaserFocus, Belgrade, Serbia
| | | | - Theo G Seiler
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
- Institut für Refraktive und Ophthalmo-Chirurgie, Zurich, Switzerland
| | - Mirko R Jankov
- Centre for Microsurgery LaserFocus, Belgrade, Serbia
- Institut für Refraktive und Ophthalmo-Chirurgie, Zurich, Switzerland
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Yang T, Chan SY, Liu J, Chen Z, Yu G, He X, Meng J. Pterygium combined with corneal perforation: a case report. BMC Ophthalmol 2023; 23:363. [PMID: 37641016 PMCID: PMC10463940 DOI: 10.1186/s12886-023-03084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 07/13/2023] [Indexed: 08/31/2023] Open
Abstract
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.
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Affiliation(s)
- Tianqi Yang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Sun Yuet Chan
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Jie Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Zhiwei Chen
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Guocheng Yu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xiaojuan He
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Jing Meng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
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Weber SLP, Jorge BCDM, Mourão ABG, Hofling-Lima AL. Late Spontaneous Postradial Keratotomy Corneal Perforation After Scleral Contact Lens Use-Case Report. Eye Contact Lens 2022; 48:534-536. [PMID: 36219770 DOI: 10.1097/icl.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a case of late spontaneous postradial keratotomy corneal perforation after scleral contact lens (SCL) wear for optic correction. SETTING Tertiary referral center for corneal pathology. DESIGN Case report. RESULTS A 64-year-old man presented the consequences of a late radial keratotomy (RK) surgery performed for myopia correction 26 years ago. His ophthalmologic history was a RK in both eyes (BE), previous Lasik surgery in BE and Lasik enhancement in the right eye (RE), and pterygium excision with conjunctival transplantation in RE. To improve visual acuity, SCL were fitted in both eyes. After 8 months of use, on a certain day, when removing the lens from the RE, the patient reported experiencing intense eye pain and reduced visual acuity. On ophthalmologic examination, the RE cornea was perforated in one of the previous RK incisions. An urgent corneal transplant was performed in the RE, followed by cataract surgery in the same eye. CONCLUSION Corneal instability caused by RK scars and daily manipulation with the SCL use may have led to ocular perforation.
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Affiliation(s)
- Sarah La Porta Weber
- Departamento de Oftalmologia (S.L.P.W., A.L.H.-L.), Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, Rua Botucatu, São Paulo, Brasil; and Faculdade de Medicina (S.L.P.W., B.C.M.J., A.B.G.M.), Universidade de Fortaleza- UNIFOR, Fortaleza, Brasil
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Shekhawat NS, Kaur B, Edalati A, Abousy M, Eghrari AO. Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation. Cornea 2022; 41:1465-1470. [PMID: 36219216 PMCID: PMC9558081 DOI: 10.1097/ico.0000000000003068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Traumatic paracentral corneal perforations may lead to irregular astigmatism and opacification from lamellar grafts. We present an alternative surgical technique using a Tenon patch graft and a conjunctival flap. METHODS A 42-year-old man presented with a 1-mm paracentral corneal perforation 6 weeks after penetrating trauma by a metallic foreign body. A region of Tenon fascia was excised and sutured to cover the perforation, and a conjunctival flap was then created and sutured over this Tenon graft. A bandage contact lens was placed postoperatively. Serial imaging was conducted to document healing including optical coherence tomography (OCT) and slit lamp photography. RESULTS At postoperative day 1, uncorrected distance visual acuity (UDVA) was hand motion, the anterior chamber was formed, and OCT revealed Tenon fascia and conjunctiva covering the defect. By postoperative week 2, the leak resolved and UDVA was 20/30. At postoperative week 4, UDVA improved to 20/20, the Tenon graft was noted to be undergoing contraction, and a single feeder vessel remained prominent in the conjunctival flap. By postoperative month 4, UDVA was 20/25 and only mild paracentral cornea clouding was noted. Initial, focal steepening and thickening normalized by month 4 leaving mild, normal astigmatism. OCT revealed integration of the Tenon graft into the corneal stroma. CONCLUSIONS For paracentral corneal perforations, a Tenon patch graft in conjunction with a conjunctival flap may aid healing with favorable postoperative refractive outcomes.
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Affiliation(s)
- Nakul Singh Shekhawat
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | | | - Armand Edalati
- University of Missouri Kansas City, Kansas City, Missouri, U.S.A
| | - Mya Abousy
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Allen Omid Eghrari
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Yeh TC, Hsu CC. Unusual Case of Secondary Corneal Perforation With Silicone Oil Leakage After Vitrectomy. Asia Pac J Ophthalmol (Phila) 2022; 11:564-565. [PMID: 36417681 DOI: 10.1097/apo.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tsai-Chu Yeh
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chien Hsu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang Ming Chiao Tung University, Taipei, Taiwan
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Suzuki T, Yamaguchi T, Tomida D, Fukui M, Shimazaki J. Outcome of Lamellar Graft Patching for the Treatment of Noninfectious Corneal Perforations. Cornea 2022; 41:1122-1128. [PMID: 34812781 PMCID: PMC9365251 DOI: 10.1097/ico.0000000000002926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/25/2021] [Accepted: 09/14/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE The aims of this study were to evaluate the clinical outcome of lamellar graft patching used for treating noninfectious corneal perforations and to determine the clinical factors affecting tectonic integrity. METHODS This retrospective study includes a total of 71 eyes of 67 patients who underwent lamellar graft patching for the treatment of corneal perforations due to persistent epithelial defects secondary to limbal stem cell deficiency (LSCD, 21 eyes; 29.6%), peripheral ulcerative keratitis (17 eyes; 23.9%), neurotrophic keratitis due to herpes simplex keratitis (HSK, 14 eyes; 19.7%), and other causes (19 eyes; 26.8%). We evaluated the tectonic integrity of the globe, visual outcomes, and postoperative complications. RESULTS Tectonic integrity was achieved in 53 eyes (74.6%). The survival proportions of eyes that achieved clear grafts were 77.8% and 65.2% at 12 and 24 months, respectively. Graft failure was observed in 19 eyes (26.8%). The survival rate of tectonic integrity and eyes that finally achieved a clear graft was significantly worse in eyes with LSCD compared with those without ( P < 0.001). The logarithm of minimal angle resolution improved significantly from 1.79 ± 0.98 to 1.22 ± 0.87 at 12 months and 1.08 ± 0.81 at 24 months. Postoperative complications included cataract formation (32 eyes, 45.1%), intraocular pressure rise (23 eyes, 32.4%), recurrent perforations (15 eyes, 21.1%), infectious keratitis (14 eyes, 19.7%), recurrence of herpes simplex keratitis (7 eyes, 9.9%), and traumatic graft dehiscence (1 eye, 1.4%). CONCLUSIONS Lamellar graft patching is an effective and safe surgical treatment for noninfectious corneal perforations; however, careful attention to severe complications is necessary, especially in eyes with LSCD.
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Affiliation(s)
- Takanori Suzuki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Daisuke Tomida
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masaki Fukui
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
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Roberts HW, Davidson M, Thaung C, Myerscough J. Early Endothelialization of Ab Interno Stromal Tectonic Patch in the Management of Corneal Perforation Secondary to Bacterial Keratitis. Cornea 2022; 41:802-805. [PMID: 34935659 DOI: 10.1097/ico.0000000000002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe a novel surgical technique using an ab interno stromal patch to treat corneal perforation and to present the histological findings of the patch after its removal during definitive mushroom keratoplasty. METHODS The endothelium had already been removed with the submerged cornea using backgrounds away (SCUBA) technique. RESULTS The patient was managed successfully with a sutureless ab interno stromal tectonic patch. Two months later, definitive mushroom keratoplasty was performed and the patch was sent for histological examination. Immunohistochemistry revealed a reactive endothelium covering the posterior surface of the graft. Nine months later, her best-corrected visual acuity was 6/9. CONCLUSIONS This is the first case to our knowledge demonstrating that stromal tectonic grafts without the endothelium can successfully attach to the host tissue and seal a perforation. The stroma may undergo reendothelialization and begin to restore vision, even before penetrating keratoplasty.
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Affiliation(s)
- Harry W Roberts
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Max Davidson
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | | | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
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Smyth A, McCabe GA, Murtagh P, McElnea EM. Tectonic Descemet's stripping automated endothelial keratoplasty for corneal perforation. BMJ Case Rep 2022; 15:e247345. [PMID: 35459648 PMCID: PMC9036169 DOI: 10.1136/bcr-2021-247345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/03/2022] Open
Abstract
We report the use of Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of sterile corneal perforation after trauma. In an eye with corneal perforation and cataract due to trauma, cataract surgery and DSAEK were performed. Corneal integrity was promptly restored and the patient avoided tectonic anterior lamellar and penetrating keratoplasty. DSAEK may be performed for the management of corneal perforation.
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Affiliation(s)
- Aoife Smyth
- Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | | | - Patrick Murtagh
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
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Chung IY, Tavassoli S, Wong N, Cleary G. Vitamin A deficiency presenting with fungal keratitis and bilateral corneal perforations. BMJ Case Rep 2022; 15:e247853. [PMID: 35288431 PMCID: PMC8921861 DOI: 10.1136/bcr-2021-247853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- In Young Chung
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Austin Health, Heidelberg, Victoria, Australia
| | - Shokufeh Tavassoli
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, Royal United Hospital NHS Trust, Bath, UK
| | - Nathan Wong
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Ophthalmology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Georgia Cleary
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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16
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Kalra N, Parmanand K, Asif MI, Bafna RK. Bandage contact lens stencil for shaped corneal transplantation surgery in a case of peripheral corneal perforation. BMJ Case Rep 2022; 15:e245252. [PMID: 35039345 PMCID: PMC8767998 DOI: 10.1136/bcr-2021-245252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nidhi Kalra
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumar Parmanand
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rahul Kumar Bafna
- Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
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17
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Hwang S, Kuo SC. Corneal perforation in ocular cicatricial pemphigoid: A CARE-compliant case report. Medicine (Baltimore) 2021; 100:e28266. [PMID: 34941105 PMCID: PMC8702268 DOI: 10.1097/md.0000000000028266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Ocular cicatricial pemphigoid (OCP) is a potentially blinding, rare systemic autoimmune disease. The definite etiology of OCP remains under debate, early diagnosis is important to prevent rapid deterioration. The majority of the discussion has been focused on its medical therapeutic strategy, while little effort has been made to study the role of amniotic membrane transplantation (AMT). We describe the first case of OCP with minimal immunosuppressant and initial ocular surface reconstruction procedure using double layer AMT. PATIENT CONCERNS A 66-year-old female patient presented to our outpatient department with right eye pain for several days. DIAGNOSIS Slit lamp examination revealed the right eye cornea perforation with iris incarceration and total collapse of anterior chamber. Symblepharon formation and severe fornix shortening was also noted. While bulbi phthisis with ankyloblepharon and ocular surface keratinization was observed in the left eye. The final diagnosis was right eye stage III ocular cicatricial pemphigoid complicated with corneal perforation and iris prolapsed. INTERVENTIONS The patient underwent ocular surface reconstruction with the aid of amniotic membrane. The first layer of the amniotic membrane was attached with tissue adhesive and fibrin glue while the second layer amniotic membrane came with a conformer ring which supported the fornix space that was recreated. Postoperative care included topical medications for inflammation alleviation. Systemic immunosuppressive agents were not administered except for oral prednisolone. OUTCOMES No recurrence of symblepharon was noted during the one year follow-up. LESSONS We aim at highlighting the possible important role of AMT in advance OCP. Further investigation is still needed for providing evidence to incorporate the procedure into treatment protocol.
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Affiliation(s)
- Suan Hwang
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Shu-Chun Kuo
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
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Fieldhouse H, Nestel A, Theron B, Knox Cartwright N. Corneal perforation due to vitamin A deficiency in a patient with short bowel syndrome. BMJ Case Rep 2021; 14:e242776. [PMID: 34511420 PMCID: PMC8438734 DOI: 10.1136/bcr-2021-242776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/03/2022] Open
Abstract
A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.
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Affiliation(s)
| | - Achim Nestel
- Ophthalmology, North Devon District Hospital, Barnstaple, UK
| | - Byron Theron
- Gastroenterology, North Devon District Hospital, Barnstaple, UK
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19
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Ramaekers A, Aspeslagh S, De Brucker N, Van Mierlo C, Ten Tusscher M, Schauwvlieghe PP, Termote K. Bilateral Corneal Perforation in a Patient Under Anti-PD1 Therapy. Cornea 2021; 40:245-247. [PMID: 33395118 DOI: 10.1097/ico.0000000000002490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Immune checkpoint inhibition has improved the clinical outcomes for numerous patients with cancer. However, the downside is a whole new spectrum of immune-related adverse events. We report a 68-year-old man with a history of nonsmall cell lung cancer presenting with a spontaneous corneal perforation in the right eye after 22 cycles of pembrolizumab. In addition, a chronic central nonhealing epithelial defect developed after performing a penetrating keratoplasty. Treatment with autologous serum drops resulted in complete healing of the corneal ulcer, where other conventional therapies had no effect. One month after reinitiating pembrolizumab therapy, our patient presented again with a corneal perforation in the fellow eye. This case describes relapsing sterile ulcerations associated with pembrolizumab use and presents an unexpected cure.
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Affiliation(s)
| | | | | | | | | | | | - Karolien Termote
- Departments of Ophthalmology; and
- Medical Oncology, UZ Brussel - VUB, Brussels, Belgium
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20
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Chan E, Buzzard J, Helms R, Grigorian AP. Evaluation and Clinical Course of Keratomalacia With Descemetocele in a Child With Autism and Vitamin A Deficiency. J Pediatr Ophthalmol Strabismus 2020; 57:e1-e3. [PMID: 31978231 DOI: 10.3928/01913913-20190812-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022]
Abstract
Autistic children with selective diets have an elevated risk for vitamin A deficiency. The authors present the case of a 7-year-old boy with keratomalacia resulting from dietary vitamin A deficiency. Optical coherence tomography and ultrasound biomicroscopy can provide useful details of the cornea and underlying structures. Vitamin A supplementation can result in significant resolution, obviating the need for surgical intervention. [J Pediatr Ophthalmol Strabismus. 2020;57:e1-e3.].
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21
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Chaparro Tapias TA, Rangel Gualdron CM, Rodriguez HA, Rodriguez LM, Flores de Los Reyes L, Sánchez España JC. Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:34-37. [PMID: 31767407 DOI: 10.1016/j.oftal.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.
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Affiliation(s)
- T A Chaparro Tapias
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - C M Rangel Gualdron
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - H A Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia; Departamento de Oftalmología, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - L M Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - L Flores de Los Reyes
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España.
| | - J C Sánchez España
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España
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Floor T, Henry YP, Kraal-Biezen E. [Corneal perforation due to 'lost' contact lenses]. Ned Tijdschr Geneeskd 2019; 163:D4177. [PMID: 31647622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An 87-year-old woman with Alzheimer's disease was referred to our eye clinic with a large corneal perforation of her right eye. On further examination a total of 15 contact lenses were found under the upper eyelid of her right eye; several lenses were also found in her left eye. During further evaluation we learned that our patient had experienced severe, recurrent and painful blepharoconjunctivitis for the past 3 years, for which she had consulted several ophthalmologists and other medical practitioners. The last time our patient had inserted a contact lens was more than 3 years previously. We therefore concluded that the retained contact lenses had caused an infectious ulcer which led to a corneal perforation. The patient underwent a perforating keratoplasty, which restored the eyesight in her right eye. Removal of the retained contact lenses gave our patient relief from her severe chronic eye pain.
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Affiliation(s)
- Thole Floor
- Amsterdam UMC, afd. Oogheelkunde, Amsterdam
- Contact: T. Floor
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Abstract
RATIONALE Terrien's marginal corneal degeneration (TMD) is characterized by progressive peripheral corneal thinning. It appears primarily above the age of 40 years and is rare at younger ages. Spontaneous corneal perforation in TMD is a rare, but serious complication that may occur in childhood. PATIENT CONCERNS This review presents the case of a 16-year-old girl presented with blurred vision in the right eye on awakening in the morning. Slit-lamp examination revealed superior corneal thinning with a corneal perforation. DIAGNOSES The best-corrected visual acuity (BCVA) was 20/50 in the right eye and 20/20 in the left eye. Intraocular pressures were 5 and 18 mm Hg in the right and left eyes, respectively, measured using a noncontact tonometer. Slit-lamp examination revealed superior corneal thinning with superficial pannus. A 1-mm corneal perforation was observed at the 11 o'clock position. The anterior chamber of the right eye was flat and the Seidel test result was positive. The left eye showed no apparent abnormality on slit-lamp examination. Corneal topography showed 4.3 D of against-the-rule astigmatism, and anterior segment optical coherence tomography revealed superior corneal thinning. We diagnosed it as childhood onset TMD. INTERVENTIONS Multilayered amniotic membrane transplantation was performed over the perforation site and a bandage contact lens was placed. OUTCOMES At 1 week postoperatively, the BCVA of the right eye improved to 20/32, the amniotic membrane graft was well-attached, and the anterior chamber remained deep. At 2 months postoperatively, the BCVA was 20/25 and the anterior chamber depth was maintained. LESSONS Spontaneous corneal perforation due to TMD is rare, but may occur in childhood. The possibility of corneal perforation should be considered even in childhood and good surgical results can be obtained with amniotic membrane transplantation.
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Affiliation(s)
- Junkyu Chung
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong
| | - Kyung Hyun Jin
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | - Jaheon Kang
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong
| | - Tae Gi Kim
- Department of Ophthalmology, Kyung Hee University Hospital at Gangdong
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24
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Nicula C, Szabo I. Complicated corneal ulcer. Case report. Rom J Ophthalmol 2016; 60:260-263. [PMID: 29450359 PMCID: PMC5711291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 06/08/2023] Open
Abstract
Corneal ulcers are considered an ophthalmologic emergency because of their potential to permanently impair vision or perforate the eye. The therapeutic management includes medical therapy and in case of failure, surgical care such as amniotic membrane transplantation. We present the case of a 76-year-old male, admitted for sudden visual loss in the left eye, associated with ocular pain, tearing, and photophobia. The patient was diagnosed with superficial ulcerative keratitis with hypopyon and acute exogenous anterior uveitis for which he underwent medical treatment, both general and topic, with a good evolution during a month. After a month, the patient presented with the corneal ulcer perforated. Surgery was performed in the left eye by covering the ocular surface with an amniotic membrane using the Motowa's sandwich technique. After one year, the same patient was successfully operated for cataract removal and posterior chamber intraocular lens implantation in the left eye.
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Affiliation(s)
- Cristina Nicula
- Ophthalmology Clinic, County Emergency Hospital Cluj-Napoca, Romania
- ”Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Izabela Szabo
- Ophthalmology Clinic, County Emergency Hospital Cluj-Napoca, Romania
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25
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Abstract
We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents.
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Affiliation(s)
- Yoly Yeuk Ying Fong
- From the Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital (YYYF, ALY, VJ); Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (MY, ALY, VJ); Department of Mathematics and Statistics, Hang Seng Management College, Hong Kong (MY); and Centre for Eye Research Australia, University of Melbourne, Victoria, Australia (VJ)
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26
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Xue C, Xia Y, Chen Y, Yang L, Huang Z. [Treatment of large corneal perforations with acellular multilayer of corneal stromal lenticules harvested from femtosecond laser lenticule extraction]. Zhonghua Yan Ke Za Zhi 2015; 51:655-659. [PMID: 26693649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To describe a novel surgical technique for the treatment of large corneal perforations by using acellular multilayer of corneal stromal lenticules. METHODS Prospective study. The acellular tissue used for the repair was harvested from myopic patients during the femtosecond laser (FS) refractive surgery. Informed consent, blood test and donor eligibility were obtained in each case. Three or four layers of lenticules were stacked up and stored at -80°C in pure sterile glycerin. The diameter is 6.0 to 6.5 mm and central thickness was 300 to 400 µm. If the diameter of the corneal ulcer perforation was larger than 3 mm and corneal grafts were not available, we used this kind of patches to seal the perforations. It was a retrospective case series study. Five cases of corneal ulcer perforation were enrolled in this study. One was neuropathic keratitis, one was atopic keratoconjunctivitis, and the other three were fungal keratitis. Acellular multilayer of stromal lenticules were used in these cases for emergent therapy. RESULTS The sealing of the perforation and the re-establishment of the anterior chamber were achieved successfully in all the cases. For the pericentral perforations, visual recovery was achieved. And efficient palliative management was done for the central perforations. CONCLUSIONS The reported technique seems to represent a good alternative emergency procedure for the management of large corneal perforations. It is a very useful method for Chinese hospitals where the shortage of cornea donors is a very serious problem and the amount of FS surgeries are increasing.
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Affiliation(s)
- Chunyan Xue
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Yuan Xia
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Yueqin Chen
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Liping Yang
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China
| | - Zhenping Huang
- Department of Ophthalmology, Nanjing General Hospital of PLA, Nanjing 210002, China;
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27
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Rana M, Lau A, Aralikatti A, Shah S. Severe microbial keratitis and associated perforation after corneal crosslinking for keratoconus. Cont Lens Anterior Eye 2014; 38:134-7. [PMID: 25435381 DOI: 10.1016/j.clae.2014.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To report two cases of microbial keratitis with subsequent corneal perforation immediately following corneal collagen crosslinking (CXL). METHODS Retrospective case note review. RESULTS First case was a 19 year old female presented with staphylococcal corneal abscess 3 days post CXL procedure. Corneal perforation occurred during hospital admission and was successfully treated with corneal gluing. Microbial keratitis eventually resolved, with both topical and systemic antibiotics therapy, resulting in a vascularized corneal scar. Second case was an 18 year old male whom developed Methicillin Resistant Staphylococcus aureus (MRSA) corneal abscess 5 days after CXL procedure for progressive keratoconus. Corneal perforation occurred 48 h after presentation and patient underwent uneventful corneal gluing. Although infective keratitis was successfully treated with topical therapy, patient had visual outcome of count fingers due to scarring. CONCLUSIONS CXL has been widely used in the treatment of corneal ectatic conditions and complications, such as infective keratitis, are uncommon post procedure. We present two cases of severe microbial keratitis with subsequent corneal perforation within 7 days of CXL. The exact mechanism for the accelerated keratolysis process is unclear. Nonetheless, patients should be well-informed of such potentially devastating complication.
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Affiliation(s)
- M Rana
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - A Lau
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom; National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - A Aralikatti
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - S Shah
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom.
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Abstract
A 24-year-old man presented with pain, sticky discharge and loss of vision in the right eye. He has had typical skin manifestations of porphyria cutanea tarda (PCT) since 6 years and ophthalmological symptom for 6 weeks. On ophthalmological examination, visual acuity was light perception in the right eye and 6/12 in the left. There were bilateral, symmetrical temporal scleromalacia along with temporal corneal melting in both eyes and perforation in the right eye. Ultrasonography B-scan (USG B-scan) revealed a retinal detachment in the right eye. Artificial tear instillation was started every hour along with topical antibiotic coverage in both eyes. Additionally, ultraviolet protective sunglasses and hat for photo-protection was advised. The vision in the right eye improved to 5/60 along with subsidence of retinal detachment on repeat USG B-scan after 3 weeks.
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Affiliation(s)
- Pratik Yeshwant Gogri
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
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29
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Abstract
A 61-year-old woman with long-standing rheumatoid arthritis presented with the sensation of a foreign body in her right eye; she reported no symptoms in her left eye. The patient had systemic symptoms associated with her rheumatoid arthritis and was taking naproxen.
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Pode-Shakked B, Shemer-Meiri L, Harmelin A, Stettner N, Brenner O, Abraham S, Schwartz G, Anikster Y. Man made disease: clinical manifestations of low phenylalanine levels in an inadequately treated phenylketonuria patient and mouse study. Mol Genet Metab 2013; 110 Suppl:S66-70. [PMID: 24206931 DOI: 10.1016/j.ymgme.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Phenylalanine (Phe) deficiency and its clinical manifestations have been previously described mostly as sporadic case reports dating back to the 1960's and 1970's. In these reports, low plasma Phe levels were associated with listlessness, eczematous eruptions and failure to gain weight, most often in infants in their first year of life. CASE REPORT Herein we describe a 9 month old female patient with known phenylketonuria, who presented with an unusual constellation of symptoms, including severe erythema and desquamation, alopecia, keratomalacia, corneal perforation, failure to thrive and prolonged diarrhea. The diagnostic possibilities of acrodermatitis enteropathica and vitamin deficiencies were ruled out, and further investigation into her medical history led to the conclusion that during the weeks preceding the hospitalization, the patient's diet consisted of the phenylalanine-free medical formula alone, without the addition of a standard infant formula or food as recommended. Subsequently, dietary control of the blood phenylalanine levels brought swift and marked resolution of the dermatological lesions, with renewal of hair growth. OBJECTIVE Following this experience, and due to the relative paucity of data regarding the clinical manifestations of low serum phenylalanine levels in humans and their putative pathogenetic mechanisms, we sought to further investigate the effects of a phenylalanine-free diet in a mouse study. MATERIALS AND METHODS For this purpose, twenty mice were randomly allocated to receive either a phenylalanine-deficient diet (n=10) or a normal diet (n=10). Weight was measured weekly, and laboratory tests were obtained including complete blood count, electrolyte studies, and phenylalanine and tyrosine levels. Finally, necropsies and histopathological examinations of different tissues were performed in selected mice, either early after diet initiation, late after diet initiation or following re-introduction of normal diets. The study was then repeated in additional two groups of mice, for a period of up to thirteen weeks, with a total of 63 mice. RESULTS Gross lesions noted on necropsy in the Phe-deficient mice included scruffy coat, tendency toward weight loss, a reduction in thymic mass, and most notably severe gastric dilation, all of which were not seen in the controls. Histologic findings included thymic depletion, hepatocellular vacuolation, and exocrine pancreatic atrophy. No histopathological lesions were evident in the brain, nor were significant lesions in the eyes. CONCLUSIONS Diagnosis of the iatrogenic condition of phenylalanine deficiency, which manifests in gastrointestinal, dermatological and ocular findings, requires a high index of suspicion. Mice fed a phenylalanine-deficient diet display to some extent similar organ involvement, although no eye abnormalities were evident.
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Affiliation(s)
- Ben Pode-Shakked
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
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Krivosheina OI, Levchenko NA, Zapuskalov IV. [Up-to-date tendency of pharmacological treatment of corneal ulcers]. Vestn Oftalmol 2012; 128:51-54. [PMID: 22741298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The review of literature is devoted to up-to-date tendency of pharmacological treatment of corneal ulcers. Depending on cause of corneal inflammation treatment should be effective using appropriate etiotropic and pathogenetic treatment. Evaluating the literature data it is obvious that a number of questions is still should be studied. Thereby a search of new effective pharmacological treatment options with minimal side effects is essential. In case of progressing ulceration with threatened corneal perforation an urgent surgery is essential.
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33
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Samoilă O, Totu L, Călugăru M. [Methods for sealing of corneal perforations]. Oftalmologia 2012; 56:34-39. [PMID: 23424761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A variety of corneal pathology can lead to corneal ulcers and perforations. A deep corneal ulcer may need surgical treatment to allow good volume restoration and reepithelisation. Corneal perforation must be sealed and when the perforation is large, the task of repairing the defect can be underwhelming. The elegant solution is the corneal transplant, but this is not always readily available, especially in undeveloped countries. We present here two cases with different solutions to seal the perforated cornea: the first one has a large peripheral defect and it is successfully sealed with scleral patch and the second one is central with small perforation and is successfully sealed with multilayered amniotic membrane. Both cases are followed for over 12 months and demonstrate good corneal restoration (both on clinical examination and corneal topography). Sclera and amniotic membrane can be used to seal corneal defects when corneal transplant is not readily available.
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Farooq MK, Prause JU, Heegaard S. Synthetic fiber from a teddy bear causing keratitis and conjunctival granuloma: case report. BMC Ophthalmol 2011; 11:17. [PMID: 21689446 PMCID: PMC3130717 DOI: 10.1186/1471-2415-11-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 06/20/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report a case of keratitis and a case of conjunctivitis caused by synthetic fibers from toy teddy bears. CASE PRESENTATION Case stories with histopathological analysis. 1) A two-year-old girl developed a severe case of keratitis and corneal ulceration. The initial treatment with various antibiotics gave no improvement and eventually the patient developed spontaneous perforation of the cornea. The corneal swabs contained no bacteria or fungi. Corneal grafting was performed and the corneal button was sent for histopathological examination. 2) A five-year-old girl presented with ocular irritation in her left eye. Examination revealed a conjunctival granuloma in the inferior fornix. The lesion was excised and histopathologically examined. RESULTS Microscopy revealed synthetic fibers embedded in the cornea and in the conjunctival granuloma. The diagnosis was confirmed by demonstration of marked birefringence of the synthetic fibers. Microscopical examination of synthetic fibers from two different types of fur (whiskers and face hairs) from the two-year-old girl's teddy bear was performed. Hairs from the face of the teddy bear were morphologically and microscopically identical with the fibers causing the severe corneal ulceration in the two-year-old girl. CONCLUSIONS Doctors should especially in small children be aware of the risk of ocular consequences of close exposure of synthetic fibers from stuffed toy animals. Corneal ulceration, clinically presenting as corneal infection with negative culturing and staining, should lead to a different clinical strategy and treatment. The treatment of conjunctival synthetic fiber granuloma is excision and antibiotic eye drops.
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Affiliation(s)
- Mohammed K Farooq
- Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark
| | - Jan U Prause
- Eye Pathology Section, University of Copenhagen, Frederik V's Vej 11, DK-2100 Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark
- Eye Pathology Section, University of Copenhagen, Frederik V's Vej 11, DK-2100 Copenhagen, Denmark
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Abstract
We report a case of corneal perforation with preseptal cellulitis in a patient with acute lymphocytic leukemia (ALL). A 17-yr-old female patient who was undergoing combination chemotherapy for ALL was referred due to upper lid swelling and pain in the right eye for 2 days. Visual acuity in the right eye was 20/20. Initial examination showed no abnormal findings, other than swelling of the right upper eyelid. Computed tomography showed a finding of preseptal cellulitis. Microbiologic study of bloody and purulent discharge revealed Serratia marcescens. Corneal melting and perforation with iris prolapse were detected in the right eye on the 16th day. Emergent tectonic keratoplasty was performed. Seven months after surgery, visual acuity in the right eye was 20/300, and the corneal graft was stable.
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Affiliation(s)
- Seong-Kyu Im
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Kyung-Chul Yoon
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju, Korea
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Nubile M, Carpineto P, Liberali T, Barile P, Lanzini M, Mastropasqua L. Amniotic membrane transplantation in a perforated corneal graft: clinical and histopathological findings. Acta Ophthalmol 2010; 88:e13-4. [PMID: 19416120 DOI: 10.1111/j.1755-3768.2008.01377.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Savino G, Colucci D, Giannico MI, Salgarello T. Amniotic membrane transplantation associated with a corneal patch in a paediatric corneal perforation. Acta Ophthalmol 2010; 88:e15-6. [PMID: 19785639 DOI: 10.1111/j.1755-3768.2009.01522.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Awan MA, Ramaesh K. Superior forniceal advancement conjunctival pedicle (SFACP) in the management of corneal perforations and impending perforations due to rheumatoid arthritis related autoimmune corneal melts. J PAK MED ASSOC 2010; 60:129-131. [PMID: 20209701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Peripheral ulcerative keratitis (PUK) is a disorder consisting of a crescent-shaped destructive inflammation of the perilimbal corneal stroma. PUK may occur in variety of systemic diseases including collagen vascular disease. We describe the outcome of superior forniceal advancement conjunctival pedicle (SFACP) in two patients with corneal perforation and impending perforation due to rheumatoid arthritis (RA) related auto immune corneal melt that has not previously been reported. Both patients had good recovery with restoration of vision when SFACP was performed as an adjunct to systemic immunosuppressive agents. SFACP is a valuable surgical option which may have an important role in reducing progression of corneal melt and underlying disease when used along with adequate systemic immunosuppressive agents.
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Affiliation(s)
- Muhammad Amer Awan
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland
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Bushley DM, Holzinger KA, Winkle RK, Le LH, Olkowski JD. Lamellar interface fluid accumulation following traumatic corneal perforation and laser in situ keratomileusis. J Cataract Refract Surg 2005; 31:1249-51. [PMID: 16039507 DOI: 10.1016/j.jcrs.2004.10.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2004] [Indexed: 11/29/2022]
Abstract
A 41-year-old man with myopic astigmatism had laser in situ keratomileusis (LASIK) in each eye in April 2002. Ten months later, he sustained a central perforating corneal injury to the right eye. One day following repair of the corneal wound, he presented with diffuse corneal epithelial microcystic edema, lamellar interface fluid accumulation, and 20/400 visual acuity. Additional sutures were placed to close a presumed posterior wound gape with complete resolution of the corneal edema and lamellar interface fluid collection. One year later, his best corrected visual acuity measured 20/20+ in the right eye. This case is the first to document lamellar interface fluid accumulation following LASIK owing to traumatic disruption of the corneal endothelium.
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Affiliation(s)
- D Matthew Bushley
- Ophthalmology Service, Tripler Army Medical Center , Honolulu, Hawaii 96859, USA
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