PURPOSE: To report a case of corneal collagen cross-linking for corneal ulcer caused by the Moraxella group.CASE SUMMARY: A 77-year-old male had decreased visual acuity for several days in his right eye. The patient showed severe stromal ring infiltrates with a corneal epithelial defect measuring (5.0 × 7.0 mm), a corneal endothelial plaque, and a hypopyon measuring less than 1.0 mm in height in the anterior chamber of the right eye. There was no abnormal finding in the right eye using B-scan ultrasonography. Before starting treatment, a corneal culture was conducted. The culture tests showed the presence of the Moraxella group. Because the patient was diagnosed with a corneal ulcer caused by the Moraxella group, corneal collagen cross-linking (CXL) was performed. The antimicrobial susceptibility test confirmed that this Moraxella group was sensitive to ceftazidime, so the patient was treated with 5% ceftazidime eye drops and 0.5% moxifloxacin eye drops every 2 hours for 9 months after corneal collagen CXL. The uncorrected visual acuity was 0.1 in the right eye, and there was almost no corneal stromal melting on anterior segment optical coherence tomography.CONCLUSIONS: This is the first known case of a corneal ulcer, in the Republic of Korea, caused by the Moraxella group and treated with corneal collagen CXL. Corneal collagen CXL should be considered as a surgical treatment for patients who have an impending corneal perforation due to a corneal ulcer because it is a simple procedure and causes fewer serious complications than other treatments.
Aged ; Anterior Chamber ; Ceftazidime ; Collagen ; Cornea ; Corneal Perforation ; Corneal Ulcer ; Freezing ; Humans ; Male ; Moraxella ; Ophthalmic Solutions ; Republic of Korea ; Tomography, Optical Coherence ; Ultrasonography ; Visual Acuity

Gonococcal conjunctivitis is rare in adults and, if not treated properly, can cause corneal perforation. Gonococcal conjunctivitis typically presents with a severe mucopurulent discharge, similar to that associated with viral conjunctivitis. Here, we describe a case of monocular gonococcal conjunctivitis, including its clinical characteristics and slit-lamp images, which was initially misdiagnosed as epidemic conjunctivitis. A 20-year-old man was referred to our hospital with no improvement in monocular infection and purulent ocular discharge after 2-wk treatment using antibiotic and 0.1% fluorometholone eye drops at the local ophthalmic clinic. Initially, 0.5% loteprednol eye drops were used since we suspected viral conjunctivitis. Following this treatment, conjunctival infection worsened and a yellow-white ocular discharge covered the conjunctiva and cornea surface. Additional history taking revealed that the patient had sexual contact with a prostitute 1 wk prior to symptom presentation and, after the encounter, he took antibiotics for genital discharge at the local urology clinic, but self-discontinued treatment. A Gram staining showed gram-negative diplococci and culture of collected ocular discharge from the palpebral conjunctiva revealed growth of Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. Following this, the patient was systemically treated with 3rd generation cephalosporin antibiotics. After 3-d treatment, conjunctival infection and purulent ocular discharge had significantly improved. When clinical symptoms are aggravated following steroid eye drop treatment for suspected monocular viral conjunctivitis, gonococcal conjunctivitis must be considered as a differential diagnosis
Adult* ; Anti-Bacterial Agents ; Cephalosporins ; Conjunctiva ; Conjunctivitis* ; Conjunctivitis, Viral ; Cornea ; Corneal Perforation ; Diagnosis, Differential ; Fluorometholone ; Humans ; Loteprednol Etabonate ; Male* ; Neisseria gonorrhoeae ; Ophthalmic Solutions ; Sex Workers ; Urology ; Young Adult

PURPOSE: We report a case of spontaneous corneal perforation combined with primary pterygium. CASE SUMMARY: A 66-year-old male presented with a foreign body sensation in his right eye. He had no systemic or ocular inflammatory diseases. He had undergone penetrating keratoplasty following amniotic membrane transplantation for corneal perforation at 1 day after pterygium excision in his left eye. The uncorrected visual acuity (UCVA) and intraocular pressure (IOP) in his right eye were 0.8 and 2 mmHg, respectively. Active leakage of an aqueous humor on the head of the pterygium was found on slit lamp examination. With the impression of spontaneous corneal perforation combined with primary pterygium, emergent amniotic membrane transplantation was performed. Diffuse corneal thinning around the 2 mm-sized perforation site was found 3mm away from the limbus in the 5 o'clock after removing the pterygium. The perforation site was covered with amniotic membrane after applying fibrin glue. UCVA and IOP in his right eye were 1.0 and 9 mmHg, respectively, at postoperative 6 months. No definite recurrence of pterygium or additional corneal perforation was found. CONCLUSIONS: Spontaneous corneal perforation may be related to primary pterygium.
Aged ; Amnion ; Aqueous Humor ; Corneal Perforation* ; Fibrin Tissue Adhesive ; Foreign Bodies ; Head ; Humans ; Intraocular Pressure ; Keratoplasty, Penetrating ; Male ; Pterygium* ; Recurrence ; Sensation ; Slit Lamp ; Visual Acuity

PURPOSE: To report a case of Terrien's marginal degeneration treated with C-type anterior lamellar keratoplasty using cryopreserved leftover cornea. CASE SUMMARY: A 63-year-old female visited our clinic because of left ocular discomfort and visual deterioration over several years. The patient had +2.25 Dsph = -5.00 Dcyl × 111° of astigmatism, and best corrected visual acuity was 20/20. Microscopic slit lamp examinations revealed an approximately 10.0 mm width semilunar shaped stromal opacity with surrounding stromal lipid deposit, as well as superficial neovascularization with thinning at superior perilimbal cornea. Anterior segment optical coherence tomography confirmed extreme thinning at the opacified cornea. The patient was diagnosed with Terrien's marginal degeneration. To prevent corneal perforation, C-type anterior lamellar keratoplasty using cryopreserved leftover cornea was performed. After 18 months after operation, donor graft was successfully attached via the anterior segment optical coherence tomography and microscopic slit lamp examination and graft rejection was not observed. CONCLUSIONS: C-type anterior lamellar keratoplasty using a cryopreserved cornea can be an effective therapeutic strategy for Terrien's marginal degeneration.
Astigmatism ; Cornea* ; Corneal Perforation ; Corneal Transplantation* ; Female ; Graft Rejection ; Humans ; Middle Aged ; Slit Lamp ; Tissue Donors ; Tomography, Optical Coherence ; Transplants ; Visual Acuity

We describe herein a case of an impending corneal perforation with a large descemetocele in a patient with previous penetrating keratoplasty (PKP) that subsequently was treated with an emergent lamellar keratoplasty using frozen preserved cornea. A 76-year-old male patient, who had a PKP, presented with a completely whitish and edematous graft accompanied by large epithelial defects. Although antibiotics and antiviral agents were tried for three days, the corneal stroma abruptly melted, except for the Descemet's membrane and endothelium. Cryopreserved corneal tissue that was kept at -80degrees C was thawed and sutured on top of the remaining Descemet's membrane and endothelium. Pathological and microbiological tests were conducted using the remaining donor and recipient corneal tissues. After tectonic corneal transplantation on top of a large descemetocele, a healthy graft and relatively clear interfaces between graft-host junctions were maintained without serious adverse reactions throughout 6 month follow-up period. Microbiological evaluations of donor tissue at the time of thawing and tissue preparation were done, and the results were all negative. Tissue that was taken intraoperatively from the recipient cornea also showed negative microbiological results. In conclusion, tectonic lamellar keratoplasty, using cryopreserved corneal tissue, only onto the remaining Descemet's membrane and endothelium in an emergent condition, was a safe and effective treatment.
Cornea/*surgery ; Corneal Perforation/pathology/physiopathology/*surgery ; Corneal Transplantation/*methods ; *Cryopreservation ; Eye Injuries, Penetrating/pathology/physiopathology/*surgery ; Female ; Humans ; Keratoplasty, Penetrating ; Male ; Middle Aged ; *Tissue Donors ; Treatment Outcome ; Visual Acuity

PURPOSE: To report a case of Paecilomyces lilacinus fungal keratitis after cataract surgery in a patient with chronic systemic and autoimmune disease who was treated with medical therapy and penetrating keratoplasty. CASE SUMMARY: A 72-year-old female was referred for decreased visual acuity and ocular pain in the left eye. She underwent cataract surgery in the left eye 1 month earlier and was treated for 2 weeks for corneal edema and stromal infiltration around the corneal suture. She had a chronic systemic disease with hypertension, hyperlipidemia, hepatitis C and rheumatoid arthritis. Suspecting infectious keratitis, the patient was instructed to stop applying topical and systemic steroids and use topical amphotericin B (0.15%) and moxifloxacin (0.5%). However, without improvement, amphotericin B (0.15%) and moxifloxacin (0.5%) were changed to natamycin (5%) and topical voriconazole (2%) and systemic voriconazole was added. However, her systemic status deteriorated and corneal melting developed, scleral graft implantation and amniotic membrane implantation were performed to prevent corneal perforation 6 weeks after the initial visit. Paecilomyces lilacinus was identified in culture at 7 weeks and penetrating keratoplasty was performed 12 weeks after the initial visit. After penetrating keratoplasty, corneal status was stable for 6 months and no signs of recurrence were observed. CONCLUSIONS: In a patient with Paecilomyces lilacinus fungal keratitis and chronic systemic and autoimmune disease, penetrating keratoplasty showed good prognosis when the disease was refractory to topical and systemic antifungal agents.
Aged ; Amnion ; Amphotericin B ; Antifungal Agents ; Arthritis, Rheumatoid ; Autoimmune Diseases* ; Cataract* ; Corneal Edema ; Corneal Perforation ; Female ; Freezing ; Hepatitis C ; Humans ; Hyperlipidemias ; Hypertension ; Keratitis* ; Keratoplasty, Penetrating ; Natamycin ; Paecilomyces* ; Prognosis ; Recurrence ; Steroids ; Sutures ; Transplants ; Visual Acuity ; Voriconazole

PURPOSE: To report a case of Descemet's membrane detachment and corneal edema caused by an iatrogenic corneal perforation created while performing a local anesthetic (lidocaine) injection into the eyelid for a hordeolum incision and a drainage procedure. The detachment resolved after 14% C₃F₈ gas and air injections into the anterior chamber. CASE SUMMARY: An 8-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection into the upper eyelid in preparation for a hordeolum incision and drainage procedure. Corneal optical coherence tomography (OCT) showed Descemet's membrane detachment. Three days after the first visit, the corneal epithelium had entirely healed. However, Descemet's membrane detachment persisted even after three weeks of follow-up. A corneal OCT was repeated after three weeks and showed a partial Descemet's membrane rupture. A more aggressive treatment method was deemed necessary, and gas and air injections into the anterior chamber were performed. After 48 hours, aside from some Descemet's membrane rolling at the site of rupture, overall reattachment of Descemet's membrane was noted. After three months of follow-up, the patient showed a stable corneal state and normalized vision. CONCLUSIONS: Descemet's membrane detachment and rupture resulting from an iatrogenic corneal perforation during an injection of lidocaine to the eyelid led to decreased visual acuity from corneal edema. As a more aggressive treatment method, 14 % C₃F₈ gas and air injections into the anterior chamber were performed and resulted in near complete reattachment of Descemet's membrane's and normalization of the patient's visual acuity.
Anesthesia, Local ; Anterior Chamber ; Child ; Corneal Edema ; Corneal Perforation ; Descemet Membrane* ; Drainage* ; Epithelium, Corneal ; Eyelids ; Female ; Follow-Up Studies ; Hordeolum* ; Humans ; Lidocaine* ; Methods ; Rupture ; Tomography, Optical Coherence ; Visual Acuity

BACKGROUNDSmall incision refractive lenticule extraction (SMILE) is an effective laser procedure that treats myopia. This research was to describe a novel approach to treat corneal ulcer or perforation using the corneal lenticules obtained from SMILE and to evaluate the safety and effectiveness of tectonic keratoplasty with femtosecond laser intrastromal lenticule (TEKIL).

METHODSA total of twenty patients (22 eyes) were monitored for at least 6 months and were assessed using slit lamp microscopy, optical coherence tomography, and best-corrected visual acuity (BCVA). Postoperative complications throughout the study period were recorded.

RESULTSCorneal ulcer in 14 patients (16 eyes) and corneal perforation in six patients (6 eyes) were treated with TEKIL. The patients were ten females and ten males, with a mean age of 58.5 ± 16.3 years (range: 16-81 years). In this study, the most causes of corneal ulcer or perforation were immunologic causes (54.5%). After TEKIL procedure, global integrity was achieved in all cases. No immune rejection or perforation was detected. The mean BCVA improved from 0.17 ± 0.20 preoperatively to 0.27 ± 0.25 postoperatively at the final follow-up (t = 2.095, P = 0.052). The postoperative BCVA improved in 12 eyes (54.5%) and maintained in nine eyes (40.9%). Vision function successfully maintained in all eyes (100%). In three cases, corneal ulcers were treated by reoperation of TEKIL at 3 months after the initial surgery for the reason that the residual corneal thickness was <250 μm.

CONCLUSIONSTEKIL seems to be an effective treatment for corneal ulcer and perforation in the condition of emergency and donor shortage.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cornea ; surgery ; Corneal Perforation ; physiopathology ; surgery ; Corneal Transplantation ; adverse effects ; methods ; Corneal Ulcer ; physiopathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; physiology ; Young Adult

PURPOSE: To describe a case of sympathetic ophthalmia due to corneal perforation caused by exposure keratitis in a patient with recurrent sphenoid wing meningioma. CASE SUMMARY: A 34-year-old female patient presented with proptosis in her left eye caused by left sphenoid greater wing meningioma despite tumor debulking surgery and radiation treatment. The cornea was perforated with prolapsed iris due to exposure keratitis, thus enucleation of the left eye was performed. After 2 weeks, an inflammatory reaction occurred in both eyes, keratic precipitates on corneal endothelium, exudative retinal detachment, and multiple granulomatous nodules on the right eye retina. The patient was diagnosed with sympathetic ophthalmia, thus enucleation of the left eye and debulking of the tumor were performed followed by a high-dose intravenous steroid therapy. At 5 months postoperatively, slit lamp biomicroscope showed no chamber reaction; improved disc swelling and exudative retinal detachment in the right eye were observed. CONCLUSIONS: Despite conservative treatment for exposure keratitis due to proptosis caused by malignant sphenoid meningioma, corneal perforation can develop. Because sympathetic ophthalmia can occur, the other eye should be monitored.
Adult ; Cornea ; Corneal Perforation* ; Endothelium, Corneal ; Exophthalmos ; Female ; Humans ; Iris ; Keratitis ; Meningioma* ; Ophthalmia, Sympathetic* ; Retina ; Retinal Detachment

PURPOSE: To report a case of successful treatment of Alternaria species infection after corneal tattooing using penetrating keratoplasty corneal perforation. CASE SUMMARY: A 65-year-old male underwent corneal tattooing for corneal opacity of the left eye. One month later, epithelial defect and necrosis of the left eye were observed, thus a smear and culture were performed and Alternaria species were cultured. He was treated with 0.3% amphotericin B-fortified eyedrops and Itraconazole oral medication; however, 3 weeks later, corneal perforation of the left eye was observed and penetrating keratoplasty was performed. Postoperatively, due to persistent increased intraocular pressure, trabeculectomy was performed. Two months later, donor cornea was well-grafted and recurrent keratitis was not observed. CONCLUSIONS: Corneal tattooing can cause damage to the corneal epithelium and anterior stroma and increase the risk of infection when using steroids. In the case of infection, detecting and differentiating the type of microorganisms are more difficult. Therefore, proper care and close monitoring for the signs of infection are important during and after the surgery.
Aged ; Alternaria* ; Amphotericin B ; Cornea ; Corneal Opacity ; Corneal Perforation ; Epithelium, Corneal ; Fungi ; Humans ; Intraocular Pressure ; Itraconazole ; Keratitis ; Keratoplasty, Penetrating ; Male ; Necrosis ; Ophthalmic Solutions ; Steroids ; Tattooing* ; Tissue Donors ; Trabeculectomy