RESUMEN
A non-diabetic woman in her 80s presented 1 week following uncomplicated left eye cataract surgery complaining of decreased vision, gritty sensation and photophobia in the same eye. Postoperative treatment included G. Acular (Ketorolac Tromethamine 0.5%, NSAID: non-steroidal anti-inflammatory drug) and G. Tobradex (Tobramycin 0.3% and Dexamethasone 0.1%, antibiotic and steroid, respectively) each prescribed four times a day for 2 weeks. On examination, the patient had a corneal epithelial defect which progressed to a full-thickness perforation despite ceasing the NSAID drops. Cyanoacrylate glue application with a plastic drape patch failed to seal the perforation, and a full-thickness tectonic corneal transplant was performed. On investigation, the patient had positive anti-RO and anti-LA antibodies, suggesting a diagnosis of Sjögren's syndrome. We advocate for careful preoperative assessment prior to cataract surgery, patient education, close follow-up and cautious medication use postoperatively including avoiding NSAID drops in patients with risk factors for postoperative dry eye disease.
Asunto(s)
Antiinflamatorios no Esteroideos , Perforación Corneal , Síndrome de Sjögren , Humanos , Femenino , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/tratamiento farmacológico , Antiinflamatorios no Esteroideos/efectos adversos , Perforación Corneal/inducido químicamente , Anciano de 80 o más Años , Extracción de Catarata/efectos adversos , Trasplante de Córnea , Complicaciones Posoperatorias/inducido químicamenteRESUMEN
BACKGROUND Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1), or its ligand PD-L1, are the mainstay treatment for several metastatic malignant conditions. ICIs are associated with multiple toxic adverse events affecting various organs, known collectively as immune-related adverse events (irAEs). Dry eye, uveitis, ocular myasthenia, and cicatrizing conjunctivitis are well-recognized ocular irAEs associated with ICIs. CASE REPORT We present a case of 69-year-old man who presented with paracentral, punch-out corneal perforation in the left eye, associated with bilateral severe ocular surface disease 3 weeks after receiving the second dose of atezolizumab-bevacizumab combination therapy for the treatment of unresectable hepatocellular carcinoma. Corneal gluing using cyanoacrylate glue was performed along with bandage contact lens application and temporary tarsorrhaphy to seal the corneal perforation and improve the ocular surface. On the subsequent follow-ups, the corneal glue was unstable and dislodged. Thus, penetrating keratoplasty was performed to salvage the globe along with holding the combination therapy. At the 8-month follow-up, the graft remained clear, and the ocular surface improved substantially in both eyes. CONCLUSIONS Ocular irAEs associated with immune-modulating agents can lead to vision-threatening complications. Therefore, communications between oncologists and ophthalmologists in a multidisciplinary team would be of utmost importance for early detection and timely management of any ocular-related adverse events associated with the use of immunotherapy agents.
Asunto(s)
Carcinoma Hepatocelular , Perforación Corneal , Neoplasias Hepáticas , Masculino , Humanos , Anciano , Carcinoma Hepatocelular/tratamiento farmacológico , Perforación Corneal/inducido químicamente , Perforación Corneal/terapia , Bevacizumab/efectos adversos , Neoplasias Hepáticas/tratamiento farmacológicoRESUMEN
PURPOSE: The aim of this study was to report a case of fungal keratitis with subsequent corneal perforation after corneal collagen cross-linking (CXL) treatment performed for keratoconus. CASE REPORT: A 20-year-old woman presented with redness and discharge in the left eye. She had a history of bilateral CXL procedure performed for keratoconus elsewhere 4 days earlier. The visual acuity was hand motion in the left eye. Slit-lamp examination revealed extended corneal melting with surrounding infiltrates. The patient was hospitalized, and corneal epithelial scraping samples were sent for microbiological assessment. In the meantime, empirical antibiotic therapy (fortified topical antibiotics: vancomycin 50 mg/mL, ceftazidime 50 mg/mL, and fluconazole 2 mg/mL q1 hour) was initiated. In direct microscopy of the corneal scraping, septate hyaline fungal hyphae were detected and topical fluconazole was switched to topical voriconazole (10 mg/mL). Three days after hospitalization, corneal melting progressed to perforation and corneal suturing with 10-0 monofilament was performed to reform the anterior chamber. Complete resolution of keratitis with residual scarring was noticed in 2 weeks. Three months later, penetrating keratoplasty was performed to obtain better visual acuity. CONCLUSIONS: CXL with riboflavin has become a common procedure to prevent keratoconus progression by strengthening the biomechanical specialties of the cornea. Although the treatment itself has been used in the management of microbial keratitis and related corneal melting, fungal keratitis and corneal perforation after a CXL procedure for keratoconus might also be detected. Clinicians should be aware of this rare but devastating complication of CXL treatment and start prompt treatment when suspected.
Asunto(s)
Perforación Corneal , Úlcera de la Córnea , Infecciones Fúngicas del Ojo , Queratitis , Queratocono , Femenino , Humanos , Adulto Joven , Adulto , Queratocono/complicaciones , Queratocono/tratamiento farmacológico , Perforación Corneal/inducido químicamente , Perforación Corneal/diagnóstico , Perforación Corneal/terapia , Reticulación Corneal , Fármacos Fotosensibilizantes/uso terapéutico , Fluconazol/uso terapéutico , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/tratamiento farmacológico , Úlcera de la Córnea/complicaciones , Queratitis/microbiología , Riboflavina/uso terapéutico , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Reactivos de Enlaces Cruzados/uso terapéutico , Rayos UltravioletaRESUMEN
PURPOSE: We report, for the first time, 2 cases of corneal ulceration and perforation after treatment with dupilumab for atopic dermatitis. METHODS: A 30-year-old woman and a 44-year-old man developed unilateral severe corneal ulceration and perforation while on dupilumab therapy after 3 and 9 months, respectively. RESULTS: Corneal cultures were negative in both cases except for scanty growth of Staphylococcus species on enrichment. Both cases progressed to perforation despite intensive topical antibiotic treatment. The first case required a tectonic keratoplasty to restore globe integrity after failed attempts of corneal gluing and multilayer amniotic membrane transplantation, and the second case was managed successfully with a cyanoacrylate glue patch. CONCLUSIONS: Although there have been previous reports of conjunctival injection and dry eye after dupilumab, these are the first 2 reports of corneal ulceration with rapid progression to perforation in patients under treatment with dupilumab. The underlying pathophysiology for ulcerative keratitis in these cases remains unknown, but there is no doubt that cessation of dupilumab prevented progression of the melting. Severe ocular symptoms while on dupilumab require a prompt discussion with the dermatology team to potentially switch treatment and halt further keratitis progression.
Asunto(s)
Perforación Corneal , Úlcera de la Córnea , Dermatitis Atópica , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Perforación Corneal/inducido químicamente , Úlcera de la Córnea/inducido químicamente , Úlcera de la Córnea/tratamiento farmacológico , Úlcera de la Córnea/cirugía , Dermatitis Atópica/tratamiento farmacológico , Femenino , Humanos , MasculinoRESUMEN
PURPOSE: To examine the rate and risk factors for band keratopathy after herpes zoster ophthalmicus (HZO) and the outcomes of ethylenediaminetetraacetic acid (EDTA) treatment. METHODS: This is a retrospective review of all subjects with HZO seen at Auckland District Health Board between January 2006 and December 2016. RESULTS: A total of 869 subjects with HZO were included in the study. Median follow-up was 6.3 years (total 5504.4 patient-years). Band keratopathy developed in 13 subjects (1.5%). On multivariate analysis, older age at onset [hazard ratio (HR), 1.092; P = 0.034], intraocular pressure ≥30 mm Hg at presentation (HR, 5.548; P = 0.013), and number of recurrences (HR, 1.849; P < 0.001) were associated with increased risk for band keratopathy. Corneal melt occurred in 22 subjects (2.5%) during the follow-up period. On multivariate analysis, uveitis (HR, 8.618; P = 0.004) and disodium EDTA chelation (HR, 8.666; P < 0.001) were associated with increased risk for corneal melt. EDTA chelation was performed in 8 subjects. Corneal melt occurred after EDTA chelation in 4 subjects, and corneal perforation occurred in 2 subjects. One subject was eviscerated due to severe endophthalmitis after repeated corneal perforation and another required enucleation for recurrent corneal melt and microbial keratitis. CONCLUSIONS: Band keratopathy is an uncommon complication of HZO. Treatment with EDTA chelation might be associated with a significant risk for severe complications in these eyes and should be approached with caution.
Asunto(s)
Quelantes del Calcio/efectos adversos , Distrofias Hereditarias de la Córnea/tratamiento farmacológico , Perforación Corneal/inducido químicamente , Úlcera de la Córnea/inducido químicamente , Ácido Edético/efectos adversos , Herpes Zóster Oftálmico/complicaciones , Anciano , Distrofias Hereditarias de la Córnea/etiología , Perforación Corneal/diagnóstico , Úlcera de la Córnea/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Agudeza VisualAsunto(s)
Corticoesteroides/efectos adversos , Perforación Corneal/inducido químicamente , Complicaciones Posoperatorias/inducido químicamente , Administración Oftálmica , Corticoesteroides/administración & dosificación , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Extracción de Catarata , Lentes de Contacto Hidrofílicos , Humanos , Masculino , Moxifloxacino/uso terapéutico , Adhesivos TisularesRESUMEN
PURPOSE: To report a rare case of spontaneous corneal perforation after hydrops in keratoconus patients who suffer from familial Mediterranean fever and was treated systemically with Colchicine. METHODS: Case report. RESULTS: We report a case of a 30-year-old male with keratoconus and familial Mediterranean fever treated with colchicine, presented with acute hydrops in his left eye, which progressed to a spontaneous corneal perforation. Attempts to treat the perforation with cyanoacrylate glue failed, and he underwent penetrating keratoplasty with an excellent visual outcome. CONCLUSION: Colchicine treatment may have had a role in the pathogenesis of this rare case.
Asunto(s)
Colchicina/efectos adversos , Perforación Corneal/inducido químicamente , Edema/inducido químicamente , Fiebre Mediterránea Familiar/tratamiento farmacológico , Queratocono/inducido químicamente , Moduladores de Tubulina/efectos adversos , Enfermedad Aguda , Adulto , Humanos , MasculinoRESUMEN
A 74-year-old man presented with a progressive decrease in visual acuity and foreign body sensation in his right eye 8 days post uncomplicated phacoemulsification cataract surgery and intraocular lens insertion. The patient had been placed on a perioperative cataract regimen which consisted of G. Maxitrol (dexamethasone, polymyxin B sulfate, neomycin sulfate) four times a day and G. Yellox twice daily (bromfenac, a non-steroidal anti-inflammatory) for 2 weeks. On examination, he had a corneal ulcer and stromal thinning in his right eye which progressed to a full thickness perforation 12 hours later. The patient required a full thickness tectonic corneal transplant. Direct questioning revealed that this patient had both dry mouth and eyes. Serology revealed that the patient was positive for rheumatoid factor and for anti-Ro and anti-La antibodies. A parotid gland biopsy revealed significant lymphocytic infiltrate consistent with Sjögren's syndrome.
Asunto(s)
Perforación Corneal/diagnóstico , Facoemulsificación , Síndrome de Sjögren/diagnóstico , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Benzofenonas/administración & dosificación , Benzofenonas/efectos adversos , Bromobencenos/administración & dosificación , Bromobencenos/efectos adversos , Perforación Corneal/inducido químicamente , Perforación Corneal/complicaciones , Perforación Corneal/cirugía , Trasplante de Córnea , Diagnóstico Diferencial , Humanos , Masculino , Soluciones Oftálmicas/administración & dosificación , Soluciones Oftálmicas/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/diagnóstico , Síndrome de Sjögren/complicacionesAsunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Benzofenonas/efectos adversos , Bromobencenos/efectos adversos , Edema Corneal/inducido químicamente , Perforación Corneal/inducido químicamente , Úlcera de la Córnea/inducido químicamente , Complicaciones Posoperatorias/inducido químicamente , Administración Oftálmica , Corticoesteroides/uso terapéutico , Anciano , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Benzofenonas/administración & dosificación , Benzofenonas/uso terapéutico , Bromobencenos/administración & dosificación , Bromobencenos/uso terapéutico , Catarata/complicaciones , Extracción de Catarata , Perforación Corneal/diagnóstico , Perforación Corneal/cirugía , Úlcera de la Córnea/cirugía , Úlcera de la Córnea/terapia , Lámina Limitante Posterior/patología , Urgencias Médicas , Adhesivo de Tejido de Fibrina/uso terapéutico , Hemorragia Gastrointestinal/inducido químicamente , Hernia/etiología , Hernia/terapia , Humanos , Instilación de Medicamentos , Enfermedades del Iris/etiología , Enfermedades del Iris/cirugía , Enfermedades del Iris/terapia , Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Masculino , Úlcera Péptica Perforada/inducido químicamente , Tomografía de Coherencia ÓpticaRESUMEN
CONTEXT: Nicorandil is an antianginal drug used for 20 years in Japan and introduced in France in 1994. Since 1997, side effects such as mucocutaneous ulcerations have regularly been reported. OBJECTIVE: To describe the first case of a patient with a spontaneous corneal perforation associated with mucocutaneous ulcerations while taking Nicorandil. MATERIALS AND METHODS: A 81-year-old patient, with no past history of ocular disease but a long past history of cardiovascular disease, presented with a spontaneous paracentral corneal perforation. This was consecutive to 5 months of recurrent keratoconjunctivitis and mucocutaneous ulcerations resistant to conventional therapy. (He was taking nicorandil for 5 years.) A penetrating keratoplasty was performed in emergency. RESULTS: Inflammatory and infectious causes of spontaneous corneal perforation were ruled out. After initial uneventful post-operative wound healing, an epithelial ulcer appeared on the graft. Dermatologists suggested the iatrogenic role of nicorandil and the drug was discontinued. Both mucocutaneous and corneal ulcerations resolved rapidly. DISCUSSION: Although mucocutaneous ulcerations have been attributed several times to nicorandil, this is, to our knowledge, the first major corneal damage due to this antianginal drug. Timing, pattern of illness, absence of other aetiology, recurrence of epithelial ulceration on the corneal graft and its spontaneous healing after nicorandil discontinuation make it highly apparent probable that nicorandil was directly involved in this corneal perforation. CONCLUSION: Ophthalmologists and dermatologists should be aware of the risk of severe but reversible corneal ulcerations in patients treated with nicorandil. A pharmacovigilance warning statement should be compulsory.
Asunto(s)
Fármacos Cardiovasculares/efectos adversos , Perforación Corneal/inducido químicamente , Úlcera de la Córnea/inducido químicamente , Nicorandil/efectos adversos , Anciano de 80 o más Años , Humanos , Masculino , Úlcera Cutánea/inducido químicamenteRESUMEN
INTRODUCTION: The harmful effect of the herbal medicine to the eye has not been well reported in the literature. OBJECTIVE: To report a case of bilateral corneal perforation following the use of traditional herbal medicine treated with conjunctival flap. CASE: A 46-year-old Fijian man initially presented with bilateral conjunctivitis, which was thought to be an allergic response to the use of herbal medicine. Vision at initial presentation was normal and he was treated conservatively. Upon review a week later, his vision had decreased to light perception in both eyes. The examination revealed bilateral corneal perforation with iris prolapse, which was then treated with a full thickness conjunctival flap in both eyes in the same sitting. Upon review at 3 weeks of intervention, his vision had improved to hand motions in the right eye and 6/60 in the left. The anterior chamber was formed on both sides. CONCLUSION: This case illustrates that the use of herbal medicine can cause corneal melting and subsequently perforations and this can be treated with a conjunctival flap.
Asunto(s)
Conjuntiva/trasplante , Perforación Corneal/inducido químicamente , Procedimientos Quirúrgicos Oftalmológicos/métodos , Plantas Medicinales/efectos adversos , Colgajos Quirúrgicos , Perforación Corneal/diagnóstico , Perforación Corneal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Agudeza VisualAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Perforación Corneal/inducido químicamente , Ectropión/inducido químicamente , Receptores ErbB/antagonistas & inhibidores , Inhibidores de Proteínas Quinasas/efectos adversos , Quinazolinas/efectos adversos , Femenino , Humanos , MasculinoAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Perforación Corneal/inducido químicamente , Ectropión/inducido químicamente , Receptores ErbB/antagonistas & inhibidores , Inhibidores de Proteínas Quinasas/efectos adversos , Quinazolinas/efectos adversos , Femenino , Humanos , MasculinoRESUMEN
PURPOSE: To describe the ocular effects associated with the administration of the systemic epidermal growth factor receptor (EGFR) inhibitors panitumumab and erlotinib. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Ten eyes of 5 patients in treatment with systemic EGFR inhibitors, 4 patients with erlotinib for end-stage lung carcinoma, and 1 patient with panitumumab for end-stage colorectal cancer. METHODS: Data collected from charts included gender, age at presentation, systemic disease, and clinical presentation in each eye. MAIN OUTCOME MEASURES: Demographics on presentation and clinical findings. RESULTS: Multiple epithelial defects were observed in all 10 eyes, corneal melting and thinning were observed in 3 eyes of 2 patients, 2 eyes of 1 patient presented with lower lid ectropion, and 2 eyes of 2 patients presented with corneal perforation, both requiring a penetrating keratoplasty. CONCLUSIONS: Severe ocular side effects, including corneal perforation, may be associated with the use of the EGFR inhibitors panitumumab and erlotinib.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Perforación Corneal/inducido químicamente , Ectropión/inducido químicamente , Receptores ErbB/antagonistas & inhibidores , Inhibidores de Proteínas Quinasas/efectos adversos , Quinazolinas/efectos adversos , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/tratamiento farmacológico , Perforación Corneal/diagnóstico , Perforación Corneal/cirugía , Ectropión/diagnóstico , Clorhidrato de Erlotinib , Femenino , Humanos , Queratoplastia Penetrante , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Panitumumab , Estudios Retrospectivos , Agudeza VisualAsunto(s)
Enfermedades de la Conjuntiva/inducido químicamente , Úlcera de la Córnea/inducido químicamente , Nicorandil/efectos adversos , Úlcera/inducido químicamente , Vasodilatadores/efectos adversos , Anciano de 80 o más Años , Perforación Corneal/inducido químicamente , Femenino , Humanos , Queratoconjuntivitis/inducido químicamente , MasculinoAsunto(s)
Perforación Corneal/inducido químicamente , Indometacina/administración & dosificación , Indometacina/efectos adversos , Administración Tópica , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Perforación Corneal/cirugía , Femenino , Humanos , Procedimientos Quirúrgicos OftalmológicosRESUMEN
PURPOSE: To report a case of acute corneal melt associated with use of bromfenac ophthalmic solution. METHODS: Case report. RESULTS: A 61-year-old man developed acute corneal melt 5 days after having combined cataract and pterygium surgery in his left eye. Postoperatively, he had been using bromfenac eyedrops four times daily along with the combination of ofloxacin and dexamethasone six times and timolol eyedrops twice daily. Ocular examination revealed the presence of asymptomatic dry eyes. He was managed conservatively with topical antibiotics, lubricants, and bandage contact lens application. The corneal melt healed completely with best-corrected visual acuity of 20/30 at 4 weeks postoperatively. CONCLUSIONS: The current case suggests that corneal melt can occur as a complication of inadvertent excessive use of topical bromfenac in the presence of preexisting ocular surface disorders. However, good visual outcome can be achieved by prompt conservative treatment if accurate diagnosis is made at an early stage.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Benzofenonas/efectos adversos , Bromobencenos/efectos adversos , Perforación Corneal/inducido químicamente , Soluciones Oftálmicas/efectos adversos , Enfermedad Aguda , Antiinflamatorios no Esteroideos/administración & dosificación , Benzofenonas/administración & dosificación , Bromobencenos/administración & dosificación , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To report a case of spontaneous corneal perforation after radiotherapy connected with long-term use of topical 0.1% diclofenac sodium. METHODS: A 31-year-old man presented with corneal melting and spontaneous corneal perforation. From his medical history, it was learned that he underwent radiotherapy for his nasopharyngeal carcinoma 25 months ago. He has been on artificial tears and topical 0.1% diclofenac sodium for 1 month for his dry eye. Diclofenac sodium was discontinued, and the corneal perforation site was sutured along with a bandage contact lens application. RESULTS: Melting area disappeared, and stromal opacity was detected at the site of corneal perforation. CONCLUSION: Use of long-term diclofenac sodium for dry eye after radiotherapy was possibly responsible for the spontaneous corneal perforation in our patient. It should always be borne in mind that topical diclofenac sodium should be used with caution in patients with compromised ocular surface.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Perforación Corneal/inducido químicamente , Diclofenaco/efectos adversos , Administración Tópica , Adulto , Carcinoma , Síndromes de Ojo Seco/complicaciones , Humanos , Masculino , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/radioterapia , Rotura Espontánea/inducido químicamenteRESUMEN
PURPOSE: We report a case of acute corneal melt with perforation in a patient with keratoconus after collagen crosslinking treatment and the use of topical diclofenac and proparacaine eyedrops. METHODS: The authors present a case report with clinicopathologic correlation. RESULTS: A patient diagnosed with keratoconus underwent corneal collagen crosslinking followed by postoperative use of ofloxacin, dexamethasone, diclofenac, and proparacaine eyedrops. He presented 1 week later with corneal melt and perforation and was treated initially with tissue glue and bandage contact lens application followed by a penetrating keratoplasty on Day 12. The graft was clear at 1 month. A histologic examination revealed corneal perforation with surrounding stromal loss and inflammatory infiltrates. CONCLUSION: Use of diclofenac sodium and proparacaine eyedrops after surgery was possibly responsible for the corneal melt in our patient. Patients who have undergone crosslinking treatment should be observed closely until the corneal epithelium heals completely.