BILATERAL SIMULTANEOUS CORNEAL PERFORATIONS IN CHRONIC OCULAR GRAFT-VERSUS-HOST DISEASE: A CASE REPORT WITH SERIAL AS-OCT IMAGING AND MULTIDISCIPLINARY MANAGEMENT
Published 2025 - 29th ESCRS Winter Meeting
Reference: PO209 | Type: Case Report (Cornea Day) | DOI: 10.82333/tbzj-xq35
Authors: Anna Marmalidou* 1 , Sotiria Palioura 2
1Ophthalmology,National and Kapodistrian University of Athens,Athens,Greece, 2Ophthalmology,Yale University School of Medicine,New Haven,United States;Ophthalmology,Bascom Palmer Eye Institute,Miami,United States;Ophthalmology,University of Cyprus Medical School,Nicosia,Cyprus
Purpose
To report a rare case of bilateral simultaneous corneal perforations associated with chronic ocular and skin graft-versus-host disease (GVHD) managed with cyanoacrylate glue, amniotic membrane transplantation, and a multidisciplinary approach, with monitoring through serial anterior segment optical coherence tomography (AS-OCT).
Setting
A tertiary eye care center specializing in corneal and ocular surface diseases.
Report of case
A 58-year-old man with a history of leukemia treated with allogeneic hematopoietic stem cell transplantation and chronic ocular and skin GVHD presented with bilateral central corneal perforations. The patient’s initial management included cyanoacrylate glue application and amniotic membrane transplantation to seal the perforations. Serial AS-OCT imaging was used to track healing. Systemic immunosuppression was intensified with oral methylprednisolone, doxycycline, and vitamin C. Topical cyclosporine, dexamethasone, and autologous serum tears were added for ocular surface stabilization. Despite successful stabilization of the corneal perforations, the patient developed phacolytic glaucoma due to an intumescent cataract. Phacoemulsification with endoillumination due to poor visibility was performed to address the cataract. The patient’s final visual acuity improved to 20/60 in the right eye and 20/125 in the left eye at 2.5 years of follow-up.
Conclusion / Take home message
This case highlights the importance of early detection and prompt management of corneal complications in ocular GVHD to prevent vision loss. Cyanoacrylate glue and amniotic membrane transplantation, in conjunction with systemic and topical immunosuppressive therapies, were effective in treating bilateral corneal perforations. Serial AS-OCT imaging was invaluable in diagnosing and monitoring healing, while timely cataract surgery was essential in preventing complications such as phacolytic glaucoma. Multidisciplinary care and regular follow-up are crucial for managing complex ocular GVHD cases.