Keratitis Treatment by Removal of Concealed Retrocorneal Plant Foreign Body

Abstract

Purpose: We report a case of keratitis that improved after removal of a causative plant foreign body from below the posterior surface of an opaque cornea. The foreign body was revealed by anterior segment optical coherence tomography (AS-OCT) and gonioscopy.Case summary: A 79-year-old woman was referred with an impression of left-eye keratitis; the eye had been injured by a branch of a tangerine tree 1 month prior. She had been given the usual topical antibiotics by a local clinic, but they were ineffective. At her initial visit, her visual acuity was only hand motion in the left eye; slit-lamp examination revealed a 3 × 3-mm corneal infiltration with a hypopyon in the anterior chamber. Despite administration of strong topical antibiotics on an hourly basis, the corneal lesion worsened. AS-OCT and gonioscopy revealed a small foreign body below the posterior surface of the cornea; this was surgically removed. The corneal opacity and corneal epithelial defects dramatically improved, and the hypopyon disappeared.Conclusions: The possibility of a residual foreign body should be considered if trauma precedes infectious keratitis that does not improve with conventional treatment and the posterior surface of the cornea is not visible because of corneal opacity. In such a case, AS-OCT and gonioscopy can be useful.