Spontaneous Corneal Perforation Research Articles

Bilateral severe Graves’ ophthalmopathy exacerbated by Ethiopian folk medicine: A case report

This case report discusses a 48-year-old Ethiopian patient with Graves’ ophthalmopathy who turned to an Ethiopian folk remedy involving medicinal smoke, leading to the exacerbation of Graves’ ophthalmopathy. Her condition deteriorated, resulting in severe visual impairment, proptosis, and spontaneous corneal perforation. This resulted in bilateral severe visual loss and evisceration of one eye. The case underscores the unique challenges of treating people of traditional cultures. Potential pathophysiological mechanisms are discussed. Physicians must be vigilant about patients’ use of traditional medicine.

A case of Phialemoniopsis curvata keratitis and literature review

We reported the case of a keratomycosis caused by an extremely rare filamentous fungus. A patient with a history of phacoemulsification and intraocular lens implantation surgery followed by bullous keratopathy and was wearing a bandage contact lens presented with signs of keratitis. Microbiological examinations revealed a filamentous fungus identified as Phialemoniopsis curvata. Penetrating keratoplasty was performed due to spontaneous corneal perforation during the treatment. P. curvata is an extremely rare agent of fungal keratitis. Although the course of infection is serious, recovery without sequela may be possible with early diagnosis and appropriate treatment.

Spontaneous Corneal Perforation in Treatment-Resistant MPO-ANCA-Associated Small Vessel Vasculitis

Spontaneous corneal perforation is a rare complication in sterile ulcerative keratitis [1]. Identifying the systemic causes is essential for optimal treatment. Anti-myeloperoxidase antibodies (MPO) are a subcategory of perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA). MPO-ANCA-associated small vessel vasculitis is a potential cause of sterile ulcerative keratitis. Being an autoimmune disorder, immunosuppressive therapy is indicated. Besides steroids, biologicals such as rituximab can be used with excellent results [2], [3].

IOCT-Assisted DSAEK Tamponade for Spontaneous Corneal Perforation with Secondary Bleb Formation in Pellucid Marginal Degeneration

Intraoperative optical coherence tomography (iOCT) is used extensively in complex anterior segment surgery, providing increased precision and thereby more safety and improved clinical outcomes. In lamellar keratoplasty, the successful application of iOCT has already been described [1]. For example, the iOCT can be used for defining the cutting depth of deep anterior lamellar keratoplasty (DALK) or for visualization of potential fluid in the interface in Descemet stripping automated endothelial keratoplasty (DSAEK) [2], [3], [4]. Moreover, for the correct corneal graft positioning in Descemet membrane endothelial keratoplasty (DMEK), a marker was previously required. The iOCT allows recognition of the corneal graft orientation and further observation of the unfolding process of the graft without the need for marking [1], [5].

Innovative Therapeutic Approaches for the Treatment of the Ocular Morbidities in Patients with EEC Syndrome.

Ectrodactyly-Ectodermal dysplasia-Clefting (EEC) syndrome is caused by heterozygous missense point mutations in the p63 gene, an important transcription factor during embryogenesis and for stem cell differentiation in stratified epithelia. Most of the cases are sporadic, related to de novo mutations arising during early-stage development. Familial cases show an autosomic dominant inheritance. The major cause of visual morbidity is limbal stem cell failure, which develops in the second to third decade of life. Patients often show ocular surface alterations, such as recurrent blepharitis and conjunctivitis, superficial microlesions of the cornea, and spontaneous corneal perforation and ulceration, leading to progressive corneal clouding and eventually visual loss. No definitive cures are currently available, and treatments to alleviate symptoms are only palliative. In this review, we will discuss the proposed therapeutic strategies that have been tested or are under development for the management of the ocular defects in patients affected by EEC syndrome: (i) gene therapy-based approaches by means of Allele-Specific (AS) siRNAs to correct the p63 mutations; (ii) cell therapy-based approaches to replenish the pool of limbal stem cells; and (iii) drug therapy to correct/bypass the genetic defect. However, as the number of patients with EEC syndrome is too limited, further studies are still necessary to prove the effectiveness (and safety) of these innovative therapeutic approaches to counteract the premature differentiation of limbal stem cells.

Spontaneous corneal perforation in treatment‐resistant MPO‐ANCA‐associated small vessel vasculitis

AbstractPurpose: Spontaneous corneal perforation is a rare complication in peripheral ulcerative keratitis (PUK). Identifying the systemic cause of PUK is essential for optimal treatment. MPO‐ANCA‐associated small vessel vasculitis is a potential cause of PUK. Being an autoimmune disorder, immunosuppressive therapy is indicated. Besides steroids, biologicals such as rituximab can be used with excellent results.Methods: In this case report, we would like to present a 83‐year‐old male patient with PUK caused by MPO‐ANCA‐positive small vessel vasculitis.Results: In this patient with PUK due to small vessel vasculitis, a spontaneous corneal perforation could not be prevented despite maximal immunosuppressive therapy. Thus, a tectonic penetrating keratoplasty à chaud was inevitable.Conclusions: Ophthalmologists should be aware of the rare complication of corneal perforation secondary to PUK caused by vasculitis.

IOCT‐assisted DSAEK tamponade for spontaneous corneal perforation with secondary bleb formation in pellucid marginal degeneration

AbstractPurpose: Intraoperative optical coherence tomography (iOCT) was initially used in vitreoretinal surgery. Nowadays, iOCT is also used in anterior segment surgery, providing increased precision and therefore more safety in complex anterior segment procedures, such as in corneal transplantation.Methods: Our case reports on a 50‐year‐old patient who suffered a spontaneous corneal perforation with secondary bleb formation on the ground of advanced pellucid marginal degeneration (PMD).Results: After initial repair with histoacryl glue, the corneal perforation was successfully managed by iOCT‐guided DSAEK tamponade. The secondary bleb resolved spontaneously.Conclusion: Intraoperative optical coherence tomography is a good additional tool in complex anterior segment surgery to reach a higher precision and to provide more safety.

An unusual case of sequential corneal perforation in pellucid marginal degeneration

Spontaneous and sequential corneal perforation is rare in pellucid marginal degeneration (PMD) in the seventh decade of life. Hence, the importance of repeated follow-up, clinical examination along with serial corneal topography even in the seventh and eighth decades of life is of utmost importance in PMD. We report a case of spontaneous corneal perforation in a 64-year-old male patient with PMD having normal corneal thickness in the right eye which was managed with primary suturing and compression sutures. The other eye was absolutely normal with normal topographic findings. Over a period of four years of follow-up, the patient developed progressive diminution of vision in both eyes and was diagnosed with cataract. Temporal phacoemulsification with toric IOL implantation was done in both eyes, following which the left eye developed spontaneous perforation after a period of two months which was also managed with primary suturing and compression sutures.

Effects of systemic targeted immunosuppressive therapy on ocular surface.

The purpose of this review is to give an overview of the corneal manifestations of targeted systemic immunotherapies and provide guidelines for management when applicable. The advent of newer systemic immunosuppressive therapy has resulted in the need for more awareness of potential ocular side effects. Side effects can range from vortex keratopathy as seen with the tyrosine kinase inhibitors, to epithelial microcysts as reported in the use of cytarabine and belantamab mafodotin, spontaneous corneal perforations have been reported with programmed death 1 inhibitors, while eyelid cicatrization has been reported epidermal growth factor inhibitors. Several immunomodulatory therapies result in conjunctivitis which tends to respond to topical lubrication and corticosteroid treatment. Most manifestations listed in the review are limited to the anterior segment; however, some may lead to retinal and optic nerve changes which can be permanently damaging. Ocular surface and corneal changes secondary to systemic immunosuppression can affect main components of the ocular surface. Although most adverse effects are reversible, few changes can be permanent and therefore close ophthalmologic monitoring is necessary.

Spontaneous corneal perforation in chronic trachoma

Spontaneous corneal perforation in chronic trachoma

Spontaneous corneal perforation complicating ocular rosacea: Case report.

IntroductionOcular rosacea is a multifactorial disease. Its pathophysiology remains unclear.The ocular manifestations of rosacea are not specific and can range from simple blepharoconjunctivitis to sight-threatening such as corneal perforation.Case reportWe report the case of a 10-year-old child who presented with a red painful right eye. Based on the clinical findings, we concluded that she had a corneal perforation on ocular rosacea. She benefited from an ipsilateral lamellar autokeratoplasty by lamellar autograft.The evolution was marked by a good healing and a good visual recovery despite a corneal scar.DiscussionOcular rosacea is a multifactorial disease, with an unclear physiopathology. Corneal involvement remains the least common, but the most challenging since serious complications can occur. Corneal perforation is the most severe.Several techniques have been reported and used in the management of corneal perforations such as conjunctival flap, amniotic membrane grafting, and the use of a corneal patch. The later, corneal autografting, remains a simple and effective technique with satisfactory anatomical results.ConclusionOcular rosacea is a pathology that is still poorly understood and of delayed diagnosis.It can lead to serious vision-threatening complications such as corneal perforation. The corneal patch is a simple, effective and efficient technique that has given good results in our case.

Surgical technique for the management of corneal perforation in brittle cornea

Brittle cornea syndrome is among the few special scenarios in ophthalmology that are a nightmare not only for the operating surgeon but also for the patient. Here, the thin and fragile corneas are unable to maintain the shape and structural integrity of the globe and are more prone to minor traumatic or spontaneous corneal perforations. Suturing a brittle cornea and closure of the corneal perforation in a brittle cornea are very challenging requiring the utmost care and special precautions. If proper measures are not taken during the surgery, it may be difficult to salvage the eye. Hence, it is imperative to diagnose appropriately, suture effectively, taking necessary preventive measures in salvaging these corneas. This manuscript aims at providing tips for handling brittle corneal perforations. It will also discuss the problems encountered during surgery, highlight the suturing techniques that can be customized, and finally give an insight into postoperative care.

Spontaneous corneal perforation in a young patient with vernal keratoconjunctivitis

AbstractPurposeSpontaneous corneal perforation is a rare complication of systemic diseases with ocular involvement such as Sjögren's syndrome, rheumatoid arthritis, graft‐versus‐host disease or ocular rosacea. There are few cases of spontaneous perforations in adult patients described in the literature associated with keratoconus (KC) or pellucid marginal degeneration (PMD). This case describes a spontaneous corneal perforation in a young patient with vernal keratoconjunctivitis.MethodsCase report.ResultsA 14‐year‐old male patient presented at the Department of Ophthalmology accompanied by his parents due to one day existing redness and hazy vision of the left eye (OS). Additionally, he noticed a sudden “water outflow from the left eye.” The patient's medical history includes vernal keratoconjunctivitis, systemic prediabetes, obesity and steatohepatitis. Slit‐lamp examination of the left eye revealed a spontaneous corneal perforation of 1.4 × 1.8 mm inferonasal with iris tamponade and a surrounding corneal melting of 4 mm. The anterior chamber had been totally flattened. The right eye was diagnosed by slit‐lamp examination with central corneal thinning and inferior peripheral vascularization. The corneal perforation was primarily treated with histoacrylic tissue glue. Antibiotic treatment with Ceftazidime and Moxifloxacin eye drops alternating every hour has been established. After one week, a progressive corneal melting in the area of the primary corneal perforation was observed. Therefore, a patch “keratoplasty à chaud” had to be performed. The postoperative course was devoid of complications. The patient was initially treated with Pred forte eye drops 4 times daily. An optical penetrating keratoplasty is planned.ConclusionsSpontaneous corneal perforation is an extremely rare but severe complication of vernal keratoconjunctivitis, which can also occur in young patients. Ophthalmologists should be aware of this rare complication and inform and treat their patients accordingly.

Spontaneous Corneal Perforation

A male patient, 59 years of age, who had undergone a pterygium operation 45 days ago in another center, applied to our clinics for itching and burning complaints. The patient was examined and thinning of the cornea at the perilimbal region and intense hyperemia, inflammation and scarred tissue in the nasal conjunctiva were observed. Additionally, the patient had chronic dacryocystitis. Firstly, an external dacryocystorhinostomy (DSR) operation was applied. Three days after the operation, corneal perforation and iris prolapse occurred. An autograft, including conjunctiva, limbus and neighbouring corneal tissue with lamellar excision from the superior region of the same eye, was taken. With the help of 10/0 monofilament nylon sutures, the autograft was implanted. In the postoperative period, the patient’s cataract, which was present before the operation, progressed. In the postoperative 6th month, a cataract operation was performed. By the postoperative 7th month, the patient’s visual acuity was 0.00 logMAR and the perforation region had recovered completely.

An unusual presentation in pellucid marginal degeneration

Spontaneous and unilateral corneal perforation in pellucid marginal degeneration is rare and has no clear-cut management protocols, although multiple treatment strategies have been described in the literature with variable outcomes. We report a case of spontaneous corneal perforation in a 64-year-old patient with normal corneal thickness, which was managed with primary suturing and compression sutures that helped not only in the acute management of the disease but in the improvement of corrected distance visual acuity by topographic regularization. Another unusual feature seen in this case is only unilateral presentation, with the fellow eye being completely normal in an elderly patient.

Keratoplasty indications and outcomes: The experience of a tertiary health center in Southeastern of Turkey

Aim: The study aims to report the indications of keratoplasty surgeries and our surgical outcomes performed in our hospital that provides tertiary health care.Materials and Methods: This retrospective study was conducted analyzing the files of the patients undergone keratoplasty for optical, therapeutic and tectonic purposes between 2014-2018. The patients' age, gender, indication for keratoplasty, preoperative and postoperative best-corrected visual acuity and surgical technique preferred, whether graft rejection developed or not during postoperative follow-ups, treatments administered to the patients developed rejection and follow-up periods were recorded.Results: The study included 200 eyes of 174 patients undergone keratoplasty. Of the eyes 180 (90%), 13 (6.5%) and 7 (3.5%) received corneal transplantation for optical purpose, for tectonic/therapeutic purpose and for cosmetic purpose respectively. The mean follow-up period was 21.7±6.2 months (range 6-48 months). Of the eyes 78 (39%), 40 (20%), 25 (12.5%), 19 (9.5%), 16 (8%), 11 (5.5%), and 9 (4.5%) were operated due to infectious/non-infectious corneal scar, pseudophakic/aphakic bullous keratopathy, graft failure/rejection, corneal dystrophy, keratoconus, keratitis/abscess and spontaneous corneal perforation respectively. Forty (20%) of the eyes developed allograft reaction. At the end of the study period, 50 (25%) eyes could not maintain graft transparency. The most common causes of inability to maintain graft transparency were endothelial failure and allograft reaction.Conclusion: Keratoplasty is an important and effective surgical method that increases visual acuity in blindness conditions caused by corneal diseases.Keywords: Cornea; graft survival; keratoplasty.

Kératoprothèse de Boston avec greffe d’aponévrose temporale : une solution quand il semble ne plus y en avoir

To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft. The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. host reaction with a persistent Seidel-positive descemetocele. Despite repeated penetrating keratoplasties, amniotic membrane (AM) transplantations, and buccal mucosal (BM) grafts, they both experienced recurrent corneal perforation. The only solution thus appeared to be Boston Type I KP surgery. One month postoperatively, the first patient had to receive a temporalis aponeurosis (TA) graft, due to thinning of the recipient graft. Six months postoperatively, his visual acuity (VA) was 1/10 without correction, and the corneal status had been stabilized. The second patient underwent KP and TA graft concurrently. Six months after surgery, VA was 2/10 uncorrected, and the local inflammation had been stabilized. Boston type I keratoprostheses constitute an alternative in cases of severe bilateral corneal blindness with perforation refractory to conventional treatment and surgery, with satisfactory visual results. Patients with preoperative severe ocular surface disease are at greater risk of postoperative keratolysis. For our patients with a higher risk, TA graft prevented corneal melt. TA seems to be more effective than AM or BM in preventing corneal thinning or melt. We would recommend performing a TA graft in combination with Boston KP surgery concurrently as first line treatment in eyes with severe ocular surface inflammation.

Non-traumatic corneal perforation in HIV immunosuppressed patients. Case series of 4 patients

Introduction: Non traumatic corneal perforations come as a result of tissue destruction from infectious and non infectious causes. Immunosuppression from HIV can lead to thinning of the cornea and can also cause sterile and non-sterile spontaneous corneal perforations. We are reporting a series of 4 cases of corneal perforation in HIV immunosuppressed patients. Clinical presentation: Case 1: Mrs. F E, a 27year old farmer presented with complain of left eye discharges of one-week duration. No history of previous eye diseases. On eye examination, visual acuity was counting finger 1m left eye.4 days later an inferonasal corneal perforation from a ruptured descemetocele was seen. HIV serology done was positive. The management was conservative. Case 2: Mr. M D.26 years old, presented with sudden onset of decreased vision in the left eye of 6 days duration. Eye examination showed a visual acuity of counting fingers and an epithelial defect localized inferiorly, which was ovoid. The ulcer perforated 4 days later. HIV test was positive and the defect was managed with a bandage contact lens and patient started on ART. Case 3: BB N, 13 months old boy, informant mother, who complained of the child was noticed to have swollen eyes, associated with purulent discharges for one month. On ocular examination; Visual acuity NCNSNM in both eyes; there was an infero- temporal perforation in the right eye and in left eye a central cornea abscess with a leaking descemetocele. HIV test was positive. The initial management was conservative. Case 4: Mr. B D. 50 years old, who presented with redness of the left eye of 3 months duration. He was a known seropositive on ARVs. Last CD4 count was 400/mm3. He had use traditional eye medication. On ocular examination, visual acuity was light perception in the left eye. The anterior segment examination in the left eye showed corneal changes with a descemetocele inferiorly and an infected ulcer at the inferior ¾ of limbus (endophthalmitis). The management was evisceration. Conclusion: Immunosuppression from HIV is a risk factor for spontaneous corneal perforation and should be routinely done and managed accordingly. Key words: Perforation, HIV, cornea.

Retained Bandage Contact Lens for More than Two Years in One Eyed Patient : A Case Report

Aim of the work: this study aimed to report a case of a bandage contact lens (BCL) retained for two years and six months in its primary position, which was associated with distinct clinical appearance over the patient's only Seeing Eye. Patient and methods: a 70-year-old one-eyed female patient with a history of systemic hypertension and poor vision in the left eye due to an old trauma was presented with right eye spontaneous corneal perforation and leak. The patient was treated with cyanoacrylate corneal glue along with a bandage contact lens (BCL). For the unknown reasons, the patient did not come for a follow-up medical care and presented after two years and six months with the retention of the BCL in its original position. Results: the retained BCL developed an atypical clinical appearance in the form of granular deposits along the edges made of mixed epithelium and mucous deposition. We hypothesize that this deposition occurred as an adaptive mechanism and aided in BCL stabilization and prevention of serious contact lens-related complications. Conclusions and Importance: to our knowledge, long-term in-place retention of BCL with distinct clinical appearance has not been characterized before. Despite the long period of retention, the lens did not migrate to the local vicinity and presented any serious complications. This report highlights the importance of appropriate patient education and counselling to ensure their compliance, thereby preventing any unfavourable future complications.

Hyperimmunoglobulin E syndrome: Genetics, immunopathogenesis, clinical findings, and treatment modalities.

The hyperimmunoglobulin E syndromes (HIESs) are very rare immunodeficiency syndromes with multisystem involvement, including immune system, skeleton, connective tissue, and dentition. HIES are characterized by the classic triad of high serum levels of immunoglobulin E (IgE), recurrent staphylococcal cold skin abscess, and recurrent pneumonia with pneumatocele formation. Most cases of HIES are sporadic although can be inherited as autosomal dominant and autosomal recessive traits. A fundamental immunologic defect in HIES is not clearly elucidated but abnormal neutrophil chemotaxis due to decreased production or secretion of interferon γ has main role in the immunopathogenesis of syndrome, also distorted Th1/Th2 cytokine profile toward a Th2 bias contributes to the impaired cellular immunity and a specific pattern of infection susceptibility as well as atopic-allergic constitution of syndrome. The ophthalmic manifestations of this disorder include conjunctivitis, keratitis, spontaneous corneal perforation, recurrent giant chalazia, extensive xanthelasma, tumors of the eyelid, strabismus, and bilateral keratoconus. The diagnosis of HIES is inconclusive, dependent on the evolution of a constellation of complex multisystemic symptoms and signs which develop over the years. Until time, no treatment modality is curative for basic defect in HIES, in terms of cytokines/chemokines derangement. Of note, bone marrow transplant and a monoclonal anti-IgE (omalizumab) are hoped to be successful treatment in future.