Interface fluid syndrome caused by the corneal perforation injury after small incision lenticule extraction: a case report.

BACKGROUND: To report a case of interface fluid syndrome (IFS) following traumatic corneal perforation repair after small incision lenticule extraction (SMILE). CASE PRESENTATION: A 23-year-old woman, with a past history of SMILE, was struck in the left eye with a barbecue prod and subsequently underwent corneal perforation repair at local hospital. Primary wound repaired with a single 10 - 0 nylon suture at the area of leakage. After the surgery, her best corrected visual acuity (BCVA) was 20/30. Four days later, she presented at our hospital with blurred vision, and interface fluid syndrome (IFS) was diagnosed. Intraoperative optical coherence tomography (iOCT) was used to guide the resuturing of the corneal perforation in the left eye, followed by anterior chamber gas injection. At the first postoperative month, the BCVA was 20/25. The corneal cap adhered closely to the stroma, the surface became smooth. CONCLUSIONS: This case illustrates that any corneal perforation following lamellar surgery, including SMILE, may lead to IFS. It is crucial to consider the depth of corneal perforation, and intraoperative optical coherence tomography (iOCT) plays a unique role in the repair procedure.

Severe Corneal Damage After Minor Eyelid Surgery: A Case Series.

OBJECTIVES: To present three cases of serious corneal complications after seemingly minor and uncomplicated eyelid surgery. METHODS: These cases emphasize the real-world risk of corneal damage after oculoplastic surgery. RESULTS: The first case is a 46-year-old man referred to our department with a corneal perforation after bilateral blepharoplasty of both upper and lower eyelids. The second case concerns a 51-year-old woman who suffered an accidental coagulation of the cornea during the removal of upper eyelid papillomas, and the third case is a 55-year-old woman who had severe corneal thinning accompanied by visual loss after an upper lid blepharoplasty. All patients were stabilized without the need for corneal transplantation, although there were significant corneal scars and sequelae. CONCLUSIONS: Although complications after esthetic oculoplastic surgery are rare, the reported cases show that corneal damage can have a major impact on the patient's vision and quality of life. Strategies such as the use of a corneal shield can be used to mitigate these risks, but their use is debated. Nevertheless, diligent postoperative care is paramount. At the first postoperative visit, a basic visual acuity measurement should be performed. In cases where reduced vision is reported, particularly when accompanied by pain, patients should be urgently referred for specialized eye care.

Wet bio-amniotic membrane plugging combined with transplantation in the treatment of small corneal perforations.

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.

Customized therapeutic deep anterior lamellar keratoplasty in perforated Mooren's ulcer: A novel technique.

We describe customized therapeutic deep anterior lamellar keratoplasty (DALK) for treating a perforated Mooren's ulcer. Slit-lamp biomicroscopy revealed corneal perforation (3.5 mm × 3.0 mm) with iris prolapse. The corneal melt extended from 9.0 o'clock to 4.0 o'clock. The peripheral edge of the ulcer was sloping, whereas the medial edge showed undermining. Immunological tests did not reveal any evidence of systemic autoimmune disease. In view of extensive peripheral corneal melt with large corneal perforation, the patient needed tectonic keratoplasty. The penetrating graft is not only technically demanding but also results in a poor visual outcome. We advised customized tectonic DALK. We used two different-sized trephines to obtain appropriate-sized donor tissue and avoided manual dissection. The post-surgery period was uneventful. He was prescribed topical steroids and oral methotrexate. He achieved 6/9 aided visual acuity at 4 months and maintained it until the last follow-up at 36 months.

Corneal Plug Keratoplasty for the Treatment of Small Corneal Perforation.

This case report describes the performance of corneal plug keratoplasty in a male patient aged 30 years who presented with corneal perforation secondary to metal foreign body.

Corneal Perforation associated with "Silent Brain Syndrome" / Perfuração corneana associada à "síndrome do cérebro silencioso"

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.

Queratoplastia penetrante con fines ópticos. Presentación de cuatro casos / Penetrating keratoplasty with optical aims. Presentation of four cases

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).

Treatment of perforated cornea with an autologous lamellar scleral graft: histologic findings / Tratamento de córnea perfurada com enxerto autônomo de esclera lamelar: achados histológicos

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.

Úlcera de Mooren: 30 años de seguimiento / Mooren's ulcer: 30 years of follow-up

CASO CLÍNICO: Mujer de 33 años de raza blanca que consultó por sensación de cuerpo extraño, epífora y dolor intenso, de un mes de evolución, en ambos ojos (AO). El examen biomicroscópico objetivó una úlcera corneal periférica bilateral. Precisó tratamiento con inmunomoduladores y fue intervenida en el ojo izquierdo de queratoplastia en corona semi-circular, queratoplastia penetrante, conjuntivo-córneo-escleroplastia, recubrimiento de mucosa bucal, osteo-queratoprótesis tibial y, finalmente, de desprendimiento de retina. DISCUSIÓN: La úlcera de Mooren es una afección corneal inmunológica que requiere tratamiento inmunomodulador, reservándose el quirúrgico ante el riesgo inminente de perforación, cuando esta ha ocurrido, o en los casos de necrosis aguda

CASE REPORT: A 33-year-old Caucasian female presented with epiphora, ocular pain, and foreign body sensation in both eyes for one month. Examination revealed bilateral peripheral corneal ulcers. The patient had been treated with immunomodulators, and she was treated in the left eye with peripheral semi-circular keratoplasty, penetrating keratoplasty, conjunctival-corneal-scleroplasty, buccal mucosal graft, tibial osteo-keratoprosthesis and finally, retinal detachment. DISCUSSION: Mooren's ulcer is an immunological corneal disease. This lesion must be treated initially with immunomodulators. Surgical treatment should be considered when a risk of corneal perforation is present, when the perforation appears, or under acute necrosis

One cornea for two patients: case report / Uma córnea para dois pacientes: relato de caso

Case reporting the use of one donor cornea for two transplantation procedures: deep anterior lamellar keratoplasty (DALK) in a case of an imminent corneal perforation caused by herpetic stromal necrosis, and Descemet stripping with endothelial keratoplasty (DSEK) in an eye with pseudophakic bullous keratopathy (PBK). Descemet's membrane (DM), denuded by stromal necrosis, served as the starting point for dissection plane and creation of the recipient bed for DALK. The next steps were excision of the diseased stroma along the edge of trephination, and transplantation of a 400-450 µm thick, manually dissected lamellar graft. The remaining posterior layers of the donor cornea, 100-150 µm thick, were used as a graft in the DSEK procedure for PBK. The integrity of the globe was saved, and best-corrected visual acuity (BCVA) of 20/40 was reached after DALK in the eye with an imminent corneal perforation. A subnormal central corneal thickness (CCT) of 430 µm did not interfere with corneal shape (43.50 x 45.50 D) and function. The graft remained attached and clear after DSEK in the eye with PBK, with BCVA of 20/30 and a CCT of 653 µm. One donor cornea can be used for two lamellar keratoplasties, DALK and DSEK. Although the described obstacles may prevent this approach from becoming widely used, it may prove useful when one is confronted with a need for an urgent anterior lamellar keratoplasty, a long list of cases for DSEK, and a shortage of donor corneas.

Relato de caso descrevendo o uso de uma córnea doadora para dois procedimentos de transplante: ceratoplastia anterior lamelar profunda (DALK) no caso de uma perfuração corneal iminente causada por necrose estromal por herpes vírus, e ceratoplastia com transplante de endotélio (DSEK) no olho com ceratopatia bolhosa em pseudofacia (PBK). A membrana de Descemet (DM), previamente desnudada pela necrose estromal, serviu como ponto de partida para o plano de dissecção e da criação do leito estromal para DALK. Os passos seguintes foram a excisão do estroma acometido até a borda da trepanação, transplante de um botão doador de aproximadamente 400-450 µm de espessura manualmente dissecado. As camadas posteriores restantes da córnea doadora, com a espessura de 100-150 µm, foram utilizadas para o procedimento DSEK no olho com PBK. A integridade do globo ocular foi mantida, e a acuidade visual melhor corrigida (BCVA) de 20/40 foi alcançada após DALK no olho com a perfuração corneal iminente. A espessura corneal central (CCT) de 430 µm abaixo da normal não interferiu com a curvatura anterior da córnea (43,50 x 45,50 D), nem com a sua função. O transplante de endotélio manteve-se tópico e transparente após DSEK no olho com a PBK, com uma BCVA de 20/30 e CCT de 653 µm. Uma córnea doadora pode ser utilizada para duas ceratoplastias lamelares, DALK e DSEK. Apesar de, devido os obstáculos descritos, pode não ser recomendada para o uso cotidiano, esta abordagem mostra-se útil nos casos da necessidade de uma ceratoplastia lamelar anterior de urgência, a longa lista para DESK e a falta de córneas doadoras.

Adhesivo de fibrina intracameral como tratamiento de perforación corneal espontánea / Intracameral fibrin glue in spontaneous corneal perforation

CASO CLÍNICO: Paciente varón de 70 años remitido a nuestro servicio por una perforación corneal en el ojo izquierdo (OI) de posible origen herpético. Se procedió a su reparación mediante la introducción de pegamento tisular de fibrina (Tissucol®) en cámara anterior, colocación de parche de membrana amniótica y lente terapéutica de gran diámetro. En el postoperatorio presentó cierre de la perforación y resolución de la fibrina intracameral sin daño endotelial. DISCUSIÓN: El pegamento tisular de fibrina puede ser utilizado en cámara anterior para tratar perforaciones corneales con excelentes resultados

CASE REPORT: A 70-year-old male was referred to our department due to a herpetic corneal perforation in the left eye. The perforation was healed with intracameral fibrin tissue sealant (Tissucol®), an amniotic membrane, and a large diameter soft contact lens. Postoperatively there were complete dissolution of the fibrin sealant and closure of the perforation without endothelial damage. DISCUSSION: Intracameral fibrin glue may be effective in the closure of corneal perforations

Perforación corneal como primera manifestación de síndorme de Sjören secundario a artritis reumatoide / Corneal melts as the initial manifestation of sjögren syndrome secondary to rheumatoid arthritis

La artritis reumatoide es una enfermedad sistémica inflamatoria crónica frecuente, de etiología desconocida. El síndrome de Sjögren puede ir asociado a dicha patología. El curso clínico de la artritis reumatoide a nivel ocular es muy variable y el diagnóstico temprano es determinante para prevenir graves complicaciones. Presentamos el caso de una mujer de 64 años de edad que acudió al Servicio de Urgencias por presentar ojo rojo bilateral con fotofobia, lagrimeo continuo, dolor y disminución de la agudeza visual. En la exploración se objetivó importante adelgazamiento del estroma corneal en OD y perforación corneal OI, que requirió recubrimiento tectónico con membrana amniótica. Los análisis serológicos mostraron los siguientes resultados: Factor Reumatoide+, ANA+, ENA Anti-Ro/SSA+, ENA Anti-La/SSB+. La paciente fue diagnosticada de Artritis Reumatoide y Síndrome de Sjögren secundario. Desde entonces, sigue un tratamiento sistémico con corticoides y azatioprina. Aproximadamente, el 25% de los pacientes desarrollan enfermedad oftalmológica, esencialmente queratoconjuntivitis seca (25%), epiescleritis, escleritis y queratitis. Estas manifestaciones son en general poco severas, pero hay un pequeño porcentaje de pacientes, como el caso que aquí presentamos, que sufren una inflamación ocular grave y que sin tratamiento inmunosupresor precozmente instaurado, pueden desarrollar úlceras corneales estériles, centrales o periféricas, que les puede llevar incluso a la perforación y destrucción del globo (AU)

Rheumatoid arthritis(RA) is a common chronic inflammatory autoinmune disease, with unknown etiology. Approximately 11-31% of RA patients have secondary Sjögren´s syndrome. Ophthalmologic manifestations of these diseases can cause corneal scarring, ulceration, infection, and even perforation; thus, although the prognosis is good for most patients with Sjögren syndrome and ophthalmologic features, individuals with complications have much guarded prognosis. We report the case of a 65 years old woman with photophobia, pain, tearing and blurred vision in both eyes. Slit lamp exam showed an important corneal melting right eye, and corneal perforation left eye, which required amniotic membrane transplantation. The diagnosis was: Rheumatoid Arthritis and secondary Sjögren´s Syndrome. Azathioprine treatment was started in combination with oral steroids. Approximately 25% of patients have ocular involvement, and keratoconjunctivitis sicca is the most frequent ocular complication. Although the prognosis is good in most cases, an early diagnosis is necessary to avoid several complications (AU)