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.

Patch endothelial keratoplasty for corneal perforations secondary to ocular surface disease: case series.

BACKGROUND: Corneal perforation is an ophthalmic emergency. The conventional management of corneal perforation can be associated with severe complications especially in patients with ocular surface disease. Endothelial keratoplasty has been suggested as an alternative surgical technique for the management of corneal perforations. We present a case series of nine patients with corneal perforation and ocular surface disease managed with secondary patch endothelial keratoplasty. METHODS: This is a retrospective case series of nine patch endothelial keratoplasties performed between 2016 and 2022 at a quaternary eye hospital in Australia. The surgical technique is similar to conventional endothelial keratoplasty except descemetorhexis was not performed. RESULTS: A total of 9 cases were treated during the review period. Eight of the nine cases had an improvement in visual acuity. One case failed to achieve corneal tectonic objective. CONCLUSION: Patch endothelial keratoplasty is a safe secondary procedure for the management of corneal perforations in patients with ocular surface disease.

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.

Pterygium combined with corneal perforation: a case report.

BACKGROUND: Pterygium is a common ocular surface disease. Pterygium combined with corneal perforation is rare. CASE PRESENTATION: A 28-year-old female patient visited our outpatient clinic due to sudden onset of blurred vision and increased tearing in her left eye. The visual acuity was 1.0 OD and intraocular pressure (IOP) of 19.5 mmHg for the right eye with no significant abnormalities found in the anterior and posterior segments. The visual acuity of her left eye was 0.06, and IOP was 6.2 mmHg. A triangular vascular membranous tissue was seen in her left eye below the nose growing into the cornea and the pupil area was not touched. Slit-lamp examination revealed a tiny round corneal perforation in 8 o'clock position of the lesion area. Hospital diagnosis was given as pterygium combined with corneal perforation. The patient was treated with levofloxacin eye drops and autologous serum-based eye drops. CONCLUSIONS: We report a rare case of pterygium combined with corneal perforation. Perforation is a very rare complication of pterygium. This patient received proper treatment and good result was seen. This article aimed to improve clinicians' understanding of pterygium.

Corneal perforation after corneal foreign body - Case Report.

Purpose: To present the case of a patient with a history of trauma and corneal foreign body in the right eye, followed by decreased visual acuity in the right eye, corneal perforation with good recovery after surgical treatment. Material and method: We report a case of a patient who presented to our clinic with a sudden decrease of visual acuity in the right eye, two months after an incident resulting in a corneal foreign body in the right eye. In the case presented, the patient applied a local medical self-treatment, an antibiotic and a topical corticosteroid. After a few weeks, the patient presented to the ophthalmologist, a foreign body was extracted from the cornea of the right eye and a topical treatment with a non-steroidal anti-inflammatory drug, a cycloplegic and an antibiotic were indicated. However, corneal perforation occurred and the patient was urgently sent to our service, where a corneal anaesthesia was also found. Results: Corneal perforation healed with a minor paracentral opacification. Discussions: Corneal perforation in our patient was due to corneal melting because of topical steroid anti-inflammatory autotherapy, late corneal foreign body extraction and topical treatment with non-steroidal anti-inflammatory drugs. Corneal anesthesia is also an important factor that enhances corneal melting and perforation. The surgical intervention performed healed the corneal perforation. Conclusions: Corneal anaesthesia and topical anti-inflammatory administration led to corneal perforation. Corneal sensitivity should be tested in patients with corneal foreign body. Corneal patching proved to be an adequate solution in this patient.

Management of corneal perforations in dry eye disease: Preferred practice pattern guidelines.

Corneal perforations in eyes with dry eye disease (DED) are difficult to manage due to the interplay of several factors such as the unstable tear film, surface inflammation, and the underlying systemic disease affecting the wound healing process, and the eventual outcome. A careful preoperative examination is required to identify the underlying pathology, and status of ocular surface and adnexa, rule out microbial keratitis, and order appropriate systemic workup in addition to assessing the perforation itself. Several surgical options are available, which include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK). The choice of procedure depends upon the size, location, and configuration of the perforation. In eyes with smaller perforations, tissue adhesives are effective treatment modalities, whereas AMT, TPG, and CPG are viable options in moderate-sized perforations. AMT and TPG are also preferable in cases where the placement of a bandage contact lens may be a challenge. Large perforations require a PK, with additional procedures such as tarsorrhaphy to protect the eyes from the associated epithelial healing issues. Conjunctival flaps are considered in eyes with poor visual potential. The management of the acute condition is carried out in conjunction with measures to improve the tear volume bearing in mind the chances of delayed epithelialization and re-perforation in these cases. Administration of topical and systemic immunosuppression, when indicated, helps improve the outcome. This review aims to facilitate clinicians in instituting a synchronized multifaceted therapy for the successful management of corneal perforations in the setting of DED.

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.

Perforation in interstitial keratitis associated with hidradenitis suppurativa: medical and surgical management.

We present a case of bilateral interstitial keratitis leading to perforation in a woman with hidradenitis suppurativa (HS). A woman in her mid-20s with a history of HS and Grave's disease was referred to the corneal service with loss of vision and pain in both eyes since childhood. She was found to have circumferential thinning and steepening affecting her peripheral cornea bilaterally. Corrected distance visual acuity with spectacles was in the right eye 6/7.5, and in the left 6/30, with local thinnest area of 209 and 217 µm in the right and left eyes, respectively. She experienced recurring episodes of redness and irritation, and perforation occurred. The corneal perforation was managed with cyanoacrylate glueing, followed by a local conjunctival flap. Systemic immunosuppression with mycophenolate mofetil and adalimumab was commenced, with improvement after 18 months of treatment. Dermatologists and ophthalmologists should be aware of this association given its potential severity.

Corneal Perforation associated with "Silent Brain Syndrome".

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.

Case Report: Corneal perforation secondary to orbital cellulitis caused by Streptococcus pseudoporcinus infection.

INTRODUCTION: This report described a rare case of corneal perforation secondary to orbital cellulitis caused by Streptococcus pseudoporcinus (S. pseudoporcinus) infection. To the best of our knowledge, only six cases of S. pseudoporcinus infection have been reported. This case report suggested that S. pseudoporcinus infection was contagious and potentially life threatening. The report emphasized the value of managing infections early to avoid serious consequences. CASE DESCRIPTION: A patient with orbital cellulitis, which progressed to corneal perforation was admitted to the hospital for right facial swelling, pain, and decreased vision in his right eye. S. pseudoporcinus infection was found after bacterial culture of pus puncture. After aggressive anti-infection and surgical treatment, the infection was eliminated, and the patient was discharged. However, the patient had sustained permanent vision loss. CONCLUSIONS: This case suggested the potential risk of corneal perforation and orbital cellulitis caused by S. pseudoporcinus infection in humans. The specific biological changes and mode of action of S. pseudoporcinus are unclear and need further investigation.

Acute hydrops followed by corneal perforation five years after corneal cross-linking for keratoconus.

We report a case of acute corneal hydrops followed by corneal perforation five years after corneal cross-linking for keratoconus. A healthy 24-year-old female patient underwent Dresden protocol cross-linking in her left eye due to advanced keratoconus. After five years of a stable cornea, she returned with epiphora, blurred vision, and a soft left eye. Acute hydrops and corneal perforation were diagnosed. There was no history of pregnancy, atopy, eye rubbing, trauma, or contact lens use. Local antibiotic and eye patching were applied. Three months after the resolution of the acute episode, she retained useful visual acuity with no need for further surgery. Although cross-linking efficiently halts keratoconus, progression can occur, leading to corneal hydrops and perforation, even in the absence of any risk factors.

Clinical outcome and course of Tenon's patch graft in corneal perforation and descemetocele.

Purpose: To assess the efficacy and clinical outcome of Tenon's patch graft (TPG) in corneal perforation and descemetocele. Methods: In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68%) or descemetocele (27, 32%) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS-OCT) were performed on every follow-up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). Results: The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow-up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48% and autoimmune disorders in 35% of cases. TPG successfully restored the globe integrity in 74 (87%) eyes (83% in perforation and 96% in descemetocele). Anatomical failure occurred in 11 eyes (13%). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. Conclusion: TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS-OCT is a valuable noninvasive tool for monitoring the graft status.

Corneal epithelial ingrowth after perforating corneal injury: a case report.

BACKGROUND: Epithelial ingrowth is a rare complication after ocular perforation and can become manifest many years after the primary trauma. CASE PRESENTATION: A 49-year-old patient presented with a positive Seidel test of unclear origin at her left eye, as well as a sharply defined anterior-stromal corneal scar at both eyes. Prior operations included a bilateral laser-assisted blepharoplasty 3 months earlier. The patient indicated to have been on holiday to France 5 months earlier, during an ongoing oak processionary moth caterpillars infestation. The examination using confocal microscopy confirmed a corneal perforation at the left eye and revealed corneal epithelial ingrowth capped with scarred stroma in both eyes. We performed a penetrating keratoplasty at the left eye. The scarred and perforated host cornea was divided into 4 pieces for further investigation: microbiology (negative), virology (negative), histology and transmission electron microscopy (TEM). Histology revealed differently structured epithelium, centrally inverted into the stroma through defects in Bowman's layer. TEM revealed full thickness corneal perforation with an epithelial plug extending to the lower third of the cornea, but without evidence of epithelial cell migration into the anterior chamber. Our differential diagnosis of the unclear positive Seidel test with epithelial ingrowth was as follows: (1) corneal perforation by hairs of the oak processionary moth caterpillar, although no hairs could be found histologically; (2) corneal perforation during laser-assisted blepharoplasty, which may be supported by the presence of pigmented cells on the posterior surface of Descemet´s membrane, pointing to a possible iris injury. CONCLUSION: Consequently, we highlighted that contact lenses can be useful, safe and inexpensive protective devices in upper eyelid procedures to protect the cornea against mechanical iatrogenic trauma.

Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation.

PURPOSE: Traumatic paracentral corneal perforations may lead to irregular astigmatism and opacification from lamellar grafts. We present an alternative surgical technique using a Tenon patch graft and a conjunctival flap. METHODS: A 42-year-old man presented with a 1-mm paracentral corneal perforation 6 weeks after penetrating trauma by a metallic foreign body. A region of Tenon fascia was excised and sutured to cover the perforation, and a conjunctival flap was then created and sutured over this Tenon graft. A bandage contact lens was placed postoperatively. Serial imaging was conducted to document healing including optical coherence tomography (OCT) and slit lamp photography. RESULTS: At postoperative day 1, uncorrected distance visual acuity (UDVA) was hand motion, the anterior chamber was formed, and OCT revealed Tenon fascia and conjunctiva covering the defect. By postoperative week 2, the leak resolved and UDVA was 20/30. At postoperative week 4, UDVA improved to 20/20, the Tenon graft was noted to be undergoing contraction, and a single feeder vessel remained prominent in the conjunctival flap. By postoperative month 4, UDVA was 20/25 and only mild paracentral cornea clouding was noted. Initial, focal steepening and thickening normalized by month 4 leaving mild, normal astigmatism. OCT revealed integration of the Tenon graft into the corneal stroma. CONCLUSIONS: For paracentral corneal perforations, a Tenon patch graft in conjunction with a conjunctival flap may aid healing with favorable postoperative refractive outcomes.