Corneal transplantation and concomitant SARS-CoV-2 infection: a case report / Transplante de córnea e infecção concomitante por SARS-CoV-2: relato de caso

ABSTRACT This report was aimed at presenting a case of neurotrophic keratitis and concomitant SARS-CoV-2 infection in a patient who has recently undergone a corneal DALK transplant. One month after corneal transplantation with adequate corneal epithelialization, the patient presented neurotrophic keratitis with a torpid course of the corneal transplant coinciding with a SARS-CoV-2 infection, with an excessive host immune response. In addition, the patient presented a re-positivization of nasopharyngeal polymerase chain reaction of SARS-CoV-2 with past disease after starting treatment with autologous serum eye drops. The implications at the ophthalmological level of SARS-CoV-2 infection may be clarified as the time the illness progresses and we learn more about how it acts. In this case, the disparity of signs and symptoms, the antecedent of corneal surgery, and the possibility of a herpetic infection as a cause of the primary leukoma suggested neurotrophic keratitis. Nonetheless, the involvement of systemic SARS-CoV-2 infection in the process, triggering an excessive host immune response at the corneal level with an increase in inflammatory cytokines must be taken into account. No relationship was found between treatment with autologous serum and re-positivization of nasopharyngeal polymerase chain reaction, presenting the patient a favorable response to treatment.

RESUMO O objetivo deste relato foi apresentar um caso de ceratite neurotrófica e infecção concomitante por SARS-CoV-2 em paciente submetido recentemente a transplante de córnea DALK. Um mês após o transplante de córnea com adequada epitelização da córnea, o paciente apresentou ceratite neurotrófica com curso tórpido do transplante de córnea, coincidindo com infecção por SARS-CoV-2, com resposta imune excessiva do hospedeiro. Além disso, o paciente apresentou repositivização da reação em cadeia da polimerase nasofaríngeo de SARS-CoV-2, com doença pregressa após iniciar tratamento com colírio de soro autólogo. As implicações a nível oftalmológico da infecção por SARS-CoV-2, podem ser esclarecidas à medida que a doença progride e aprendemos mais sobre sua forma de atuação. Neste caso, a disparidade de sinais e sintomas, o antecedente de cirurgia de córnea e a possibilidade de infecção herpética como causa do leucoma primário sugeriram ceratite neurotrófica. No entanto, deve-se levar em consideração o envolvimento da infecção sistêmica por SARS-CoV-2 no processo, desencadeando uma resposta imune excessiva do hospedeiro no nível da córnea, com aumento de citocinas inflamatórias. Não foi encontrada relação entre o tratamento com soro autólogo e a repositivização da reação em cadeia da polimerase nasofaríngea, apresentando ao paciente uma resposta favorável ao tratamento.

Effect of lubricating eyedrops on ocular light scattering as a measure of vision quality in patients with dry eye.

PURPOSE: To determine light scattering by the eye as a measure of optical quality using the Optical Quality Analysis System in patients with mild to moderate dry-eye disease and to examine change patterns after lubricating eyedrop use. SETTING: Hospital Clínico San Carlos, Madrid, Spain. DESIGN: Evaluation of diagnostic test or technology. METHODS: Eyes with mild to moderate dry-eye disease (study group) and healthy eyes (control group) were examined in a single visit. All patients completed a questionnaire to assess dry-eye disease symptoms (ocular surface disease index [OSDI]). Signs of dry eye were recorded as the tear breakup time, Schirmer I test, and corneal staining score. Scattered light was measured as the objective scatter index (OSI) at 0.5-second intervals over 20 seconds without blinking. The measurements were repeated 5, 10, 20, 30, 45, and 60 minutes after eyedrop instillation, and the OSI change rate was calculated. RESULTS: The OSI was significantly higher in the study group (25 eyes) than in the control group (10 eyes). After eyedrop instillation in the study group, the OSI change rate decreased significantly from baseline at each time point (P<.001, 45 minutes; P<.01, 60 minutes). No significant differences in the OSI change rate were detected between time points except between 45 minutes and 60 minutes (P<.01). A correlation was observed in all the dry-eye variables except the corneal staining score. CONCLUSION: Lubricating eyedrops improved ocular scattering in patients with mild to moderate dry eye for at least 60 minutes after instillation. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Confocal microscopy in ocular argyrosis.

PURPOSE: To identify the presence of silver deposits in the cornea using a new-generation confocal microscopy technique. METHODS: Case report. RESULTS: A 70-year-old man, who had been a jeweler for many years, was referred to our center for assessment of corneal opacity and ocular pigmentation. Slit-lamp examination revealed grayish, dense confluent deposits in the central and peripheral cornea, deep stroma, and Descemet's membrane. On confocal microscopy, we observed typical images of hyperreflective keratocytes across the entire stromal surface and two hyperreflective plaques coinciding with areas of metal deposition, one at Descemet's membrane and the other at Bowman's membrane. This last deposition site has not been previously identified in vivo by confocal microscopy. CONCLUSIONS: Confocal microscopy is a useful tool for the diagnosis of corneal argyrosis because it allows the in vivo visualization of silver deposits at different corneal levels.