RESUMO
PURPOSE: To report aetiology, characteristics, treatment and main outcomes of non-traumatic corneal perforations in a single referral centre. METHODS: A retrospective review of clinical records of patients diagnosed with non-traumatic corneal perforation. The analysed data included demographic characteristics, medical history, initial and final corrected distance visual acuity (CDVA), perforation aetiology, size, location, initial therapy, surgical treatment, ocular integrity and complications. A comparison between non-infectious and infectious groups was performed. Different variables were analysed through a multiple logistic regression analysis for the probability to have at least one more procedure. RESULTS: We included 127 eyes of 116 patients with a mean age of 50â years and a mean follow-up of 11â months. The initial CDVA was 3.00 logarithm of the minimum angle of resolution (logMAR) and the final CDVA was 2.30 logMAR (p>0.5). Regarding treatment, of the 49 eyes with an initial cyanoacrylate patch, 35 eyes (71.4%) had at least one more procedure performed (p>0.001). In comparison, of the 49 eyes with an initial tectonic penetrating keratoplasty (PK), 33 (67.3%) eyes remained stable while 16 (32.7%) eyes needed one or more interventions (p=0.004). In a multiple logistic regression analysis, an initial cyanoacrylate patch represented a probability of 4.7 times to require a subsequent procedure in comparison with an initial PK. Overall, globe integrity was achieved in 96.1% of the cases. CONCLUSIONS: Corneal perforations represent an important cause of ocular morbidity. The use of a cyanoacrylate patch is useful as an initial therapy in corneal perforations; however, procedures such as PK are often necessary to achieve anatomical success, especially in non-infectious aetiologies.
Assuntos
Perfuração da Córnea , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bandagens , Criança , Pré-Escolar , Perfuração da Córnea/complicações , Perfuração da Córnea/etiologia , Perfuração da Córnea/terapia , Cianoacrilatos/administração & dosagem , Infecções Oculares/etiologia , Infecções Oculares/microbiologia , Feminino , Humanos , Ceratoplastia Penetrante/métodos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Acuidade Visual , Adulto JovemRESUMO
Conjunctival ulceration accompanied with secretion and pain was observed in a 30-year-old male, 3 days after a perforating corneal trauma. Cultures of conjunctival ulcer samples grew Fonsecaea pedrosoi, a major causative agent of chromoblastomycosis that is typically transmitted during trauma. The conjunctival ulcer was successfully treated with amphotericin B, itraconazole, and fluconazole. This case report summarizes the diagnosis and treatment of a conjunctival ulcer due to F. pedrosoi, which is a rare complication of contaminated ocular trauma. To the best of our knowledge, this is the first reported case of F. pedrosoi causing acute conjunctival ulceration in the literature.
Assuntos
Ascomicetos/patogenicidade , Cromoblastomicose/microbiologia , Doenças da Túnica Conjuntiva/microbiologia , Perfuração da Córnea/microbiologia , Úlcera da Córnea/microbiologia , Adulto , Antifúngicos/uso terapêutico , Ascomicetos/isolamento & purificação , Cromoblastomicose/terapia , Doenças da Túnica Conjuntiva/terapia , Córnea/microbiologia , Perfuração da Córnea/complicações , Perfuração da Córnea/terapia , Úlcera da Córnea/terapia , Humanos , Masculino , Resultado do TratamentoRESUMO
ABSTRACT Conjunctival ulceration accompanied with secretion and pain was observed in a 30-year-old male, 3 days after a perforating corneal trauma. Cultures of conjunctival ulcer samples grew Fonsecaea pedrosoi, a major causative agent of chromoblastomycosis that is typically transmitted during trauma. The conjunctival ulcer was successfully treated with amphotericin B, itraconazole, and fluconazole. This case report summarizes the diagnosis and treatment of a conjunctival ulcer due to F. pedrosoi, which is a rare complication of contaminated ocular trauma. To the best of our knowledge, this is the first reported case of F. pedrosoi causing acute conjunctival ulceration in the literature.
RESUMO O quadro clínico de uma úlcera conjuntival acompanhada de secreção e dor foi observado em homem de 30 anos de idade, 3 dias após um trauma perfurante da córnea. As culturas de uma amostra retirada da úlcera conjuntival foi positiva para Fonsecaea pedrosoi, uma cromoblastomicose, geralmente transmitido após traumatismos. O caso foi tratado com sucesso com a anfotericina B, itraconazol e fluconazol. Este relato de caso reporta o diagnóstico e tratamento de uma úlcera conjuntival causada por F. pedrosoi, que raramente é visto nos olhos expostos a traumatismos contaminados. Até onde sabemos, este é o primeiro caso relatado na literatura de F. pedrosoi causando úlcera conjuntival aguda.