FROM HAND MOVEMENT TO DRIVING ABILITY: A TWO-YEAR MANAGEMENT OF A ONE-EYE PATIENT WITH COMPLICATED NEUROTROPHIC ULCER

To present the step-by-step management and beyond our expectations positive outcome of neurotrophic ulcer in a one-eye patient with glaucoma and cataract.

Ocular surface and Glaucoma Service, Ophthalmology Dpt, Konstantopouleio Gen. Hptl., Athens, Greece  12/2020-01/2023.

A 55-year-old psychiatric, one-eyed patient (depression) with reduced blinking, advanced cataract and uncontrolled glaucoma on four medications, was referred to our clinic with a central extended neurotrophic left eye corneal ulcer and visual acuity of HM.

During the following 2 months, along with topical treatment, amniotic membrane transplantation, plugs and partial tarsorrhaphy were performed in steps.  The slow course of epithelialization led to glucose testing and uncontrolled diabetes was found and treated. To eliminate drugs toxicity most of glaucoma drops were gradually discontinued, while tacrolimus ointment was started. Six months later, improvement of the cloudy cornea allowed for successful extra-capsular cataract extraction, but not for phacoemulsification due to limited visibility.

Two years after initial examination, and while the patient continued, by his own, the tacrolimus ointment use, his final visual acuity was 8/10 (Snellen chart), with almost clear cornea. IOP was controlled with one drug with full VF. The patient was driving and has stopped his psychiatric medications.

Beyond our expectations the positive outcome of this complicated patient’s problem with neurotrophic ulcer drive the question; if the continuous use of tacrolimus, along with the continuous monitoring and decisive approach are needed for a favorable outcome.