RESUMO
PURPOSE: Wet bio-amniotic membrane plugging combined with transplantation is a novel option that combined amniotic membrane plugging with amniotic membrane transplantation for the treatment of small corneal perforations. This study aimed to evaluate the efficacy of wet bio-amniotic membrane plugging in the treatment of small corneal perforations and compared it with that of the penetrating keratoplasty procedure. METHODS: Forty patients (41 eyes) with small corneal perforations <3 mm in diameter treated at our hospital between July 2018 and January 2021 were retrospectively included. Among them, 21 eyes were treated with wet bio-amniotic membrane plugging (wet bio-amniotic membrane plugging group), and 20 eyes were treated with penetrating keratoplasty procedure (penetrating keratoplasty procedure group). The best-corrected visual acuity, anterior chamber formation, corneal thickness, primary disease control, postoperative complications, and graft survival rate were assessed. RESULTS: No significant difference in baseline characteristics was found between the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups (p>0.05). The postoperative control rates of primary diseases in the wet bio-amniotic membrane plugging and penetrating keratoplasty procedure groups were 95.2% and 90.0%, respectively (p=0.481). Visual acuity was improved 6 months after the operation in the wet bio-amniotic membrane plugging group and was improved at postoperative 1 month in the penetrating keratoplasty procedure group. The formation time of the anterior chamber in the wet bio-amniotic membrane plugging group was significantly shorter than that in the penetrating keratoplasty procedure group (p=0.023). The corneal thickness of the two groups significantly increased 12 months after the operation; however, the degree of thickening in the penetrating keratoplasty procedure group was higher than that in the wet bio-amniotic membrane plugging group (p<0.001). During the follow-up, postoperative complications were not different between the two groups (p>0.999). CONCLUSION: The results suggest that wet bio-amniotic membrane plugging is effective and safe in the treatment of small corneal perforations. Thus, it can be used as an emergency treatment alternative to penetrating keratoplasty procedure for small corneal perforations.
Assuntos
Perfuração da Córnea , Humanos , Perfuração da Córnea/cirurgia , Âmnio , Estudos Retrospectivos , Câmara Anterior , Complicações Pós-OperatóriasRESUMO
ABSTRACT This case report describes the clinical characteristics and ophthalmic management of a patient who developed corneal perforation due to severe enophthalmos consistent with "silent brain syndrome." A 27-year-old man with a history of congenital hydrocephalus and ventriculoperitoneal shunt was referred with complaints of "sinking of the eyeballs" and progressively decreasing vision in the left eye. Examination revealed severe bilateral enophthalmos in addition to superonasal corneal perforation with iris prolapse in the left eye. The patient underwent therapeutic keratoplasty the next day. Orbital reconstruction with costochondral graft and shunt revision of the intracranial hypotension were performed the next month to prevent further progression.
RESUMO Este relato de caso descreve as características clínicas e o manejo cirúrgico de um paciente que teve perfuração da córnea devido à enoftalmia grave consistente com a "síndrome do cérebro silencioso". Um homem de 27 anos com história de hidrocefalia congênita e derivação ventrículo-peritoneal foi encaminhado com queixas de "afundamento dos globos oculares" e diminuição progressiva da visão no olho esquerdo. O exame revelou enoftalmo bilateral importante, além de perfuração superonasal da córnea com prolapso iriano no olho esquerdo. A paciente foi submetida à ceratoplastia terapêutica no dia seguinte. Foi realizado no mês seguinte a reconstrução da órbita com enxerto costocondral e revisão do shunt para evitar progressão e piora do caso.
Assuntos
Humanos , Adulto , Perfuração da Córnea , Encéfalo , Perfuração da Córnea/cirurgia , Perfuração da Córnea/etiologiaRESUMO
PURPOSE: The purpose of this study was to describe the deep phenotype of congenital corneal opacities (CCO) in patients with 22q11.2 deletion syndrome (22q11.2 DS) and to identify putative regions or genes that could explain the CCO. METHODS: A retrospective chart review was conducted to identify patients with 22q11.2 DS seen in the ophthalmology clinic of a tertiary referral children's hospital. Thirty patients were identified, with molecular confirmation. Twenty-six did not show structural anterior segment anomalies aside from posterior embryotoxon (n = 4), whereas 4 had bilateral CCO, of which 3 had preoperative images. We reviewed medical, operative, and pathology reports; anterior segment optical coherence tomography; high-frequency ultrasound; histopathologic slides; and genetic testing. To identify putative genes responsible for CCO, chromosomal breakpoints in patients with and without CCO were compared. RESULTS: In the 3 patients with preoperative imaging and CCO, a pattern of paracentral corneal opacification with central clearing accompanied by iridocorneal or keratolenticular adhesions was observed. Anterior segment optical coherence tomography and histopathologic images showed central stromal thinning with a residual structure consistent with Descemet membrane. One patient presented at birth with unilateral corneal perforation, suggestive of likely stromal thinning. A comparison of the breakpoints across all cases failed to reveal unique regions or genes in patients with CCO. CONCLUSIONS: 22q11.2 DS can rarely be associated with CCO. We describe a consistent pattern of central clearing related to posterior stromal thinning, with or without ICA/KLA. Possible candidate genes for corneal opacification in 22q11.2 DS remain elusive.
Assuntos
Opacidade da Córnea , Perfuração da Córnea , Síndrome de DiGeorge , Anormalidades do Olho , Humanos , Opacidade da Córnea/diagnóstico , Opacidade da Córnea/genética , Opacidade da Córnea/congênito , Síndrome de DiGeorge/diagnóstico , Síndrome de DiGeorge/genética , Anormalidades do Olho/diagnóstico por imagem , Anormalidades do Olho/genética , Estudos RetrospectivosRESUMO
This case report describes the clinical characteristics and ophthalmic management of a patient who developed corneal perforation due to severe enophthalmos consistent with "silent brain syndrome." A 27-year-old man with a history of congenital hydrocephalus and ventriculoperitoneal shunt was referred with complaints of "sinking of the eyeballs" and progressively decreasing vision in the left eye. Examination revealed severe bilateral enophthalmos in addition to superonasal corneal perforation with iris prolapse in the left eye. The patient underwent therapeutic keratoplasty the next day. Orbital reconstruction with costochondral graft and shunt revision of the intracranial hypotension were performed the next month to prevent further progression.
Assuntos
Perfuração da Córnea , Humanos , Adulto , Perfuração da Córnea/etiologia , Perfuração da Córnea/cirurgia , EncéfaloRESUMO
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.
Assuntos
Edema da Córnea , Perfuração da Córnea , Ceratocone , Humanos , Feminino , Adulto Jovem , Adulto , Ceratocone/complicações , Ceratocone/tratamento farmacológico , Ceratocone/cirurgia , Perfuração da Córnea/etiologia , Crosslinking Corneano , Edema/complicações , Edema da Córnea/etiologia , Topografia da CórneaRESUMO
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.
Assuntos
Lentes de Contato , Perfuração da Córnea , Ceratomileuse Assistida por Excimer Laser In Situ , Ceratotomia Radial , Ferida Cirúrgica , Masculino , Humanos , Pessoa de Meia-Idade , Perfuração da Córnea/etiologia , Perfuração da Córnea/cirurgia , Córnea/patologia , Ceratotomia Radial/efeitos adversos , Lentes de Contato/efeitos adversos , Ferida Cirúrgica/patologiaRESUMO
PURPOSE: To analyze the epidemiological profiles of evisceration and enucleation cases in the ophthalmologic emergency department of a Brazilian tertiary hospital. METHODS: Patients treated in the ophthalmologic emergency department of Hospital São Paulo (Universidade Federal de São Paulo) during the period 2013 to 2018 were retrospectively evaluated. Urgent cases of evisceration or enucleation surgery were included, and elective cases were excluded. The following information was extracted from the patients' medical records: demographic data, immediate and associated reasons for the surgical procedure, informed visual acuity, symptom duration until ophthalmologic care, complications, distance from the residence to the tertiary hospital, and time of hospitalization. RESULTS: In total, 61 enucleations and 121 eviscerations were included in this study. The patients had a mean age of 63.27 ± 18.68 years. Of the patients, 99 were male (54.40%), and 83 were female (45.60%). The indications for evisceration or enucleation were corneal perforation with (44.50%) and without (23.63%) signs of infection, endophthalmitis (15.38%), ocular trauma (14.29%), neoplasia (0.55%), burn accident (1.10%), and phthisis bulbi (0.55%). The self-reported visual acuity was no light perception (87.36%) or light perception (1.10%). However, 3.30% of the patients did not cooperate with the examination, and no information on visual acuity was available for the remaining 8.24%. The mean symptom duration before ophthalmologic care was sought was 18.32 days. Two patients had sympathetic ophthalmia after evisceration. CONCLUSIONS: More eviscerations than enucleations were performed throughout the study period. The most common demographic characteristics were age >60 years and male sex. The main indications for urgent evisceration and enucleation procedures were corneal perforation with and without infection, endophthalmitis, and ocular trauma. The findings from this study could guide clinicians in performing preventive measures to avoid destructive eye procedures.
Assuntos
Perfuração da Córnea , Endoftalmite , Traumatismos Oculares , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Evisceração do Olho , Centros de Atenção Terciária , Estudos Retrospectivos , Perfuração da Córnea/cirurgia , Brasil/epidemiologia , Enucleação Ocular , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/cirurgia , Traumatismos Oculares/etiologia , Endoftalmite/epidemiologia , Endoftalmite/cirurgia , Endoftalmite/etiologia , Serviço Hospitalar de EmergênciaRESUMO
Primary biliary cirrhosis is a rare progressive autoimmune liver disease that causes chronic cholestasis. Of patients with primary biliary cirrhosis, 75% develop secondary Sjogren syndrome and could develop vitamin A deficiency. Here, we report the case of a patient with primary biliary cirrhosis who developed a secondary Sjogren syndrome and vitamin A deficiency, which led to severe and unusual eye involvement with multiple and recurrent spontaneous corneal perforations. Corneal perforations in patients with primary biliary cirrhosis and secondary Sjogren syndrome are rare but devastating complications, in contrast to other eye clinical manifestations of the disease.
Assuntos
Doenças Autoimunes , Perfuração da Córnea , Cirrose Hepática Biliar , Síndrome de Sjogren , Deficiência de Vitamina A , Perfuração da Córnea/etiologia , Perfuração da Córnea/cirurgia , Humanos , Cirrose Hepática Biliar/complicações , Síndrome de Sjogren/complicações , Deficiência de Vitamina A/complicaçõesRESUMO
INTRODUCTION: To report a case of unilateral corneal perforation due to isolated ocular lichen planus. METHODS: Interventional case report. Informed consent by the patient was obtained to publish clinical images. A 64-year-old male presented with severe vision loss and a 2-week history of corneal perforation treated with penetrating keratoplasty in the left eye. He had a longstanding diagnosis of severe chronic dry eye disease. On the initial assessment a visual acuity of 20/50 in the RE and HM perception in the left eye were documented. Biomicroscopy revealed subepithelial fibrosis on the tarsal conjunctiva and clinical signs of severe dry eye disease in both eyes. A clear corneal button and a white cataract were observed in the left eye. No other skin or mucosal lesions were observed. RESULTS: An excisional biopsy of the bulbar conjunctiva was performed under topical anesthesia. Direct immunofluorescence analysis revealed a linear deposit of fibrinogen in the basement membrane consistent with ocular lichen planus. Clinical improvement was achieved using aggressive topical lubrication, corneal epithelial regenerators, topical tacrolimus, and immunosuppressive therapy with systemic corticosteroids and cyclophosphamide. CONCLUSION: Isolated ocular lichen planus is an extremely infrequent presentation of lichen planus often indistinguishable from other cicatricial conjunctivitis. Corneal perforation is a severe complication associated with severe dry eye, not previously reported with ocular lichen planus. An adequate clinical assessment and histopathologic diagnosis are crucial to lead prompt treatment and prevent sight-threatening complications.
Assuntos
Perfuração da Córnea , Oftalmopatias , Líquen Plano , Túnica Conjuntiva , Córnea , Perfuração da Córnea/diagnóstico , Perfuração da Córnea/etiologia , Perfuração da Córnea/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
RESUMEN La queratoplastia penetrante ha sido el procedimiento empleado, de forma casi universal, para el tratamiento de las patologías corneales que afectan de forma irreversible a la visión. Se reportaron 4 casos clínicos de pacientes con afecciones corneales con compromiso visual severo, dado por visión de cuenta dedos y percepción luminosa. Luego de la evaluación completa en cada caso, se decidió realizar la queratoplastia penetrante con fines ópticos, con el objetivo de recuperar la transparencia de la córnea y la calidad visual. No existieron complicaciones transquirúrgicas y fueron seguidos según protocolo de evaluación postoperatoria de trasplante corneal. Los resultados y evaluación fueron satisfactorios, al año mantenían la transparencia del injerto y se logró mejoría considerable de la agudeza visual (AU).
ABSTRACT Penetrating keratoplasty has been a procedure used, almost universally, to treat corneal diseases affecting vision in an irreversible way. Four clinical cases are reported of patients with corneal affections severely compromising vision, given by short vision and luminous perception. After completely evaluating each case, the authors decided to perform the penetrant keratoplasty with optical aims, to recover cornea transparency and the vision quality. There were not transurgical complications and the patients were followed up according to the protocols of post-surgery evaluation of corneal graft. The results and evaluation were satisfactory; after a year, the transparency of the graft was maintained and visual acuity substantially improved (AU).
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Transplante de Córnea/métodos , Ceratoplastia Penetrante/métodos , Doenças da Córnea/cirurgia , Oftalmologia , Visão Ocular/fisiologia , Doenças da Córnea/diagnóstico , Perfuração da Córnea/cirurgia , Perfuração da Córnea/diagnóstico , Ceratocone/cirurgia , Ceratocone/diagnósticoRESUMO
RESUMEN La perforación corneal es una emergencia médica que por su gravedad puede poner en peligro la integridad del globo ocular. Se informan los resultados en una serie de 25 pacientes y sus 25 ojos con perforación corneal de diversas etiologías, los cuales constituyen el mayor porcentaje de pacientes con queratopatía herpética a quienes se les realizó queratoplastias primarias terapéuticas, así como dos retrasplantes ópticos, en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras". El 83,4 por ciento de los ojos fueron conservados con agudeza visual desde 0,05 a 0,8 con corrección óptica(AU)
ABSTRACT Corneal perforation is a medical emergency whose severity may jeopardize the integrity of the eyeball. Results are presented of a series of 25 patients and their 25 eyes with corneal perforation of varying etiologies. This group constitutes the largest percentage of patients with herpetic keratopathy undergoing primary therapeutic keratoplasties. Two of them underwent optical retransplantation at Hermanos Ameijeiras Clinical Surgical Hospital. Of the total eyes, 83.4 percent were preserved, with a visual acuity of 0.05 to 0.8 with optical correction(AU)
Assuntos
Humanos , Transplante de Córnea/métodos , Ceratite Herpética/etiologia , Perfuração da Córnea/etiologiaRESUMO
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.
Assuntos
Candidíase/cirurgia , Enucleação Ocular , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae/isolamento & purificação , Panoftalmite/cirurgia , Antibacterianos/uso terapêutico , Candidíase/microbiologia , Coinfecção/cirurgia , Terapia Combinada , Perfuração da Córnea/etiologia , Progressão da Doença , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Pessoa de Meia-Idade , Celulite Orbitária/tratamento farmacológico , Celulite Orbitária/cirurgia , Panoftalmite/tratamento farmacológicoRESUMO
Se describe el caso clínico de un paciente de 72 años de edad, con diagnóstico de pénfigo vulgar, quien fue asistido en la consulta de Oftalmología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba porque padecía enrojecimiento ocular, unido a disminución de la visión y secreciones abundantes de aproximadamente 5 días de evolución. En el examen oftalmológico se confirmó la presencia de úlcera corneal bilateral por perforación infecciosa. Se indicó tratamiento con colirios de antibióticos (ceftazidima y amikacina), antiinflamatorio no esteroideo, agentes antihipertensivos y lente de contacto, con lo cual mejoraron las lesiones de ambos ojos. El proceso infeccioso pudo deberse a cierta susceptibilidad a los esteroides e inmunosupresores sistémicos, como terapia asociada al pénfigo vulgar, o al mecanismo autoinmune característico de esta dermatopatía.
The case report of a 72 years patient is described, with diagnosis of pemphigus vulgaris who went to the Ophthalmology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba because he suffered from ocular redness, together with a decrease vision and abundant secretions of approximately 5 days of history. In the ophthalmological examination the presence of bilateral corneal ulcer was confirmed due to infectious perforation. Treatment was indicated with antibiotic eyewashes (ceftazidime and amikacine), non esteroidal anti-inflammatory drugs, antihypertensive agents and contact lens, with which the injuries of both eyes improved. The infectious process could be due to certain susceptibility to the steroids and systemic inmunosupressors, as therapy associated with pemphigus vulgaris, or to the autoinmune mechanism characterizing this dermatopathy.
Assuntos
Úlcera da Córnea , Úlcera da Córnea/tratamento farmacológico , Pênfigo , Perfuração da Córnea , Soluções OftálmicasRESUMO
We report an unusual case of an amelanotic melanoma in a 7 year old hispanic child with subclinical globe perforation. Uveal melanoma rarely occurs in children. Young affected patients are mostly light-colored eye Caucasian adolescents. Since they are not common, these tumors are usually not recognized and misdiagnosed. Differential diagnoses and therapeutic options are outlined.
Assuntos
Perfuração da Córnea/etiologia , Neoplasias da Íris/complicações , Melanoma Amelanótico/complicações , Criança , Diagnóstico Diferencial , Enucleação Ocular , Hemorragia Ocular/etiologia , Humanos , Neoplasias da Íris/diagnóstico , Neoplasias da Íris/patologia , Neoplasias da Íris/cirurgia , Masculino , Melanoma Amelanótico/diagnóstico , Melanoma Amelanótico/patologia , Melanoma Amelanótico/cirurgiaRESUMO
Objetivo: Determinar la eficacia del recubrimiento conjuntival en afecciones corneales. Métodos: Se realizó un estudio descriptivo retrospectivo de corte transversal, entre los años 2015 y 2017 en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. La muestra quedó conformada por 52 pacientes quienes asistieron a la consulta externa del Servicio de Córnea de la mencionada institución. Resultados: Predominó el sexo masculino con el 63,5 por ciento de los pacientes. El grupo etario comprendido entre los 50 y 59 años de edad representó el 26,9 por ciento. Entre las afecciones corneales, el mayor porcentaje correspondió al descemetocele (30,8 por ciento), seguido de las úlceras corneales (23,1 por ciento). La técnica más empleada fue el recubrimiento conjuntival total representada por el 46,2 por ciento de las cirugías realizadas. El 80,8 por ciento de los casos evolucionó a la cicatrización corneal. La complicación más frecuente fue la retracción del colgajo (9,6 por ciento). Conclusiones: Los recubrimientos conjuntivales resultan un simple y eficaz procedimiento quirúrgico en pacientes que no responden a tratamiento médico o perforaciones corneales menores o iguales a 3 mm. Es un procedimiento extraocular que puede realizarse de urgencia para disminuir el dolor y la inflamación y puede ser revertido para realizar cirugías con fines visuales en un segundo tiempo(AU)
Objective: To determine the effectiveness of the conjunctival flap to treat corneal diseases. Methods: Retrospective, descriptive and cross-sectional study was carried out from 2015 to 2017 at "Ramon Pando Ferrer" Cuban Institute of Ophthalmology. The sample was made up of 52 patients who went to the outpatient Service of the Corneal Department of the institution. Results: Males represented 63.5 % of patients. The 50-59 y group represented 26.9 percent. Among the corneal diseases, descemetocele exhibited the highest percentage (30.8 percent) followed by corneal ulcers (23.1 percent). The most used surgical technique was the total conjunctival flap in 46.2 percent of surgeries. 80.8 percent of patients evolved into corneal scarring. The most frequent complication was flap retraction (9.6 percent). Conclusions: The conjunctival flaps represent a simple and effective surgical procedure in patients who do not respond to medical treatment or in corneal perforations equal or under 3 mm. This is an extraocular procedure that may be performed in emergency in order to release pain and inflammation and may be reversed later to perform surgeries aimed at visual problems(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos/efeitos adversos , Perfuração da Córnea/etiologia , Lesões da Córnea/cirurgia , Epidemiologia Descritiva , Estudos Transversais , Estudos RetrospectivosRESUMO
RESUMEN Se presenta un caso clínico de un varón de 27 años de edad, con una ectasia corneal y presencia de queratoglobo en ambos ojos. La manifestación clínica fue disminución lenta y progresiva de la agudeza visual en ambos ojos y dolor en el ojo izquierdo. Al examen oftalmológico se constató hidrops corneal agudo en ojo izquierdo y otras complicaciones corneales, propias de esta anomalía. Se realizó un estudio oftalmológico que permitió un diagnóstico certero. Se aplicó la terapéutica correspondiente y se sugirieron otras opciones terapéuticas (AU).
ABSTRACT We present the clinical case of a male patient, aged 27 years, with corneal ectasia and keratoglobus in both eyes. The clinical manifestation was progressive and slow decrease of the visual acuity in both eyes and pain in the left eye. At the ophthalmologic examination, acute corneal hydrops was found in the left eye, and also other complications that are proper of this anomaly. An ophthalmologic study was carried out that lead to an accurate diagnosis. The correspondent therapy was applied and several therapeutic options were suggested (AU).
Assuntos
Humanos , Masculino , Adulto , Atropina/uso terapêutico , Transtornos da Visão , Doenças da Córnea/diagnóstico , Pessoas com Deficiência Visual , Perfuração da Córnea/prevenção & controle , Ceratocone/diagnóstico , Acuidade Visual , Topografia da Córnea , Óculos , Ceratocone/congênito , Ceratocone/etiologia , Ceratocone/tratamento farmacológico , Ceratocone/epidemiologiaRESUMO
PURPOSE: To report the indications, outcomes, and complications of therapeutic penetrating keratoplasty (Th PK) in patients with corneal perforation and/or nonhealing corneal ulceration. METHODS: A retrospective review was conducted of 51 eyes of 51 patients undergoing Th PK between January 1, 2006 and April 15, 2016. Data collected included patient demographics, visual acuity (VA), size of the corneal infiltrate and epithelial defect, degree of corneal thinning/perforation, microbiological results, surgical details, and postoperative complications. RESULTS: The average age at presentation was 56.0 years (range 6-92 years), and most of the patients were females (n=31, 60.8%). Th PK was performed for corneal perforation in 28 eyes (54.9% of cases), nonhealing corneal ulcer in 16 eyes (31.4% of cases), and imminent risk of corneal perforation in 7 eyes (13.7% of cases). Infection was the most common reason for performing a Th PK and was present in 92.3% (47/51) of all cases. Of the infectious cases, the most common etiologies were bacterial (44.7%, 21/47) and fungal (31.9%, 15/47). The most common identifiable risk factor for undergoing a Th PK was a history of contact lens wear, which was seen in 32.7% of patients. Initial anatomic success was achieved in all patients after performing Th PK. Most patients (33/51; 64.7%) had clear grafts at their last follow-up examination. There was an improvement in VA in 70.2% (33/47, where data were available) of the patients at the final postoperative visit compared with the preoperative visit. Average best postoperative VA (1.14±0.88 logarithm of the minimum angle of resolution [LogMAR]; 20/276) was significantly better than the presenting (1.98±0.68 LogMAR; 20/1910) and preoperative (2.18±0.55 LogMAR; 20/3,027) visual acuities (P<0.0001). The most common complication after Th PK was cataract, which was present in 81.8% (27/33) of phakic eyes in which lens status could be assessed, followed by graft failure (47.1%; 24/51), and secondary glaucoma (45.1%; 23/51). Five eyes developed infection in the therapeutic graft, four eyes had persistent corneal epithelial defect at their last follow-up visit, and two eyes underwent evisceration. CONCLUSIONS: Therapeutic penetrating keratoplasty achieves anatomic success and it is a useful procedure for restoring a stable cornea in cases in which infection fails to heal or when the cornea perforates. Furthermore, Th PK achieves corneal clarity and improves vision in most patients.
Assuntos
Perfuração da Córnea/cirurgia , Úlcera da Córnea/cirurgia , Ceratoplastia Penetrante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Córnea/patologia , Perfuração da Córnea/fisiopatologia , Úlcera da Córnea/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Acuidade Visual/fisiologia , Adulto JovemRESUMO
We report a case of central corneal perforation treated with an autologous lamellar scleral graft and histologic findings obtained after a subsequent penetrating keratoplasty. A corneal perforation within a large Pseudomonas ulcer in a 55-year-old male rigid gas permeable contact lens wearer was sealed by a lamellar scleral graft from the same eye, followed by an uneventful penetrating keratoplasty 6 months later. Histology of the excised button revealed that the well-apposed graft, which maintained the irregular arrangement of the scleral collagen fibers, was embedded in the corneal stroma over the deep blood vessels and a rupture in Descemet's membrane. The clinical and histologic findings showed that autologous lamellar scleral grafts can be successfully used for the emergency treatment of corneal perforation when a corneal transplant is not available. The distinctive scleral structure revealed by histology and the inadequate graft transparency indicate that visual rehabilitation of eyes with a central corneal perforation can be achieved only by a subsequent optic penetrating keratoplasty.
Assuntos
Perfuração da Córnea/cirurgia , Ceratoplastia Penetrante/métodos , Esclera/transplante , Córnea/patologia , Perfuração da Córnea/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Esclera/patologia , Transplante Autólogo , Resultado do Tratamento , Acuidade VisualRESUMO
ABSTRACT We report a case of central corneal perforation treated with an autologous lamellar scleral graft and histologic findings obtained after a subsequent penetrating keratoplasty. A corneal perforation within a large Pseudomonas ulcer in a 55-year-old male rigid gas permeable contact lens wearer was sealed by a lamellar scleral graft from the same eye, followed by an uneventful penetrating keratoplasty 6 months later. Histology of the excised button revealed that the well-apposed graft, which maintained the irregular arrangement of the scleral collagen fibers, was embedded in the corneal stroma over the deep blood vessels and a rupture in Descemet's membrane. The clinical and histologic findings showed that autologous lamellar scleral grafts can be successfully used for the emergency treatment of corneal perforation when a corneal transplant is not available. The distinctive scleral structure revealed by histology and the inadequate graft transparency indicate that visual rehabilitation of eyes with a central corneal perforation can be achieved only by a subsequent optic penetrating keratoplasty.
RESUMO Relatamos um caso de perfuração corneana central tratada com enxerto autólogo lamelar de esclera e os achados histológicos obtidos após ceratoplastia penetrante (CP) subsequente. Uma perfuração da córnea devido a uma grande úlcera por Pseudomonas em um usuário de lentes de contato rígidas gás permeável de 55 anos de idade foi selada por um enxerto escleral lamelar do mesmo olho, seguida de ceratoplastia penetrante, sem intercorrências, seis meses depois. A histologia do botão excisado revelou que um enxerto bem posicionado, que manteve o arranjo irregular das fibras de colágeno escleral, foi incorporado no estroma corneano sobre os vasos sanguíneos profundos e uma ruptura na membrana de Descemet. Os achados clínicos e histológicos demonstraram que o enxerto autônomo de esclerose lamelar pode ser usado com sucesso como tratamento de emergência da perfuração da córnea, quando o transplante de córnea não é possível. A estrutura escleral característica revelada pela histologia e a transparência inadequada do enxerto indicam que a reabilitação visual dos olhos com uma perfuração corneana central só pode ser alcançada através de uma ceratoplastia penetrante óptica subsequente.