CORNEAL ULCER AND NEUROTROPHIC KERATOPATHY IN 40 YEAR OLD PENETRATING KERATOPLASTY GRAFT-CASE PRESENTATION
Published 2025 - 29th ESCRS Winter Meeting
Reference: PO295 | Type: Presented Poster & Poster | DOI: 10.82333/ckga-am89
Authors: Marija Radenkovic* 1 , Jasmina Jocic DJordjevic 2 , MARIJA TRENKIC 2 , MAJA PETROVIC 1 , SASA MIJATOVIC 1 , DALIU MUHAMER 3 , Milica Vasovic 4
1Eye Clinic , Clinical Center Nis,Nis,Serbia, 2Eye Clinic , Clinical Center Nis,Nis,Serbia;MedicAL fACULTY nIS,Nis,Serbia, 3HEALTHCENTERPRESEVO,pRESEVO,Serbia, 4hEALTH cENTER nis,Nis,Serbia
Purpose
Corneal ulcer is an inflammatory/infective condition involving disruption of epithelial layer with involvement of the corneal stroma. Caused by infection(bacterial,viral, parasitary), blepharitis, eyelashes, chemical burns, surgery, injury. Neurotrophic keratopathy(NK) is corneal degenerative disease caused by impairment of trigeminal innervation, characterized by decreased corneal sensitivity, healing impairment, ulceration, melting. Hallmark of NK is decrease of corneal sensation. Ethyology: herpes keratitis, burns/trauma, surgery, stroke,aneurismus. Penetrating keratoplasty(PKP) could be complicated by graft rejection due to host immune response. Risk factors: young age, large graft, inflammation, neovascularization.
Setting
Case of complicated PKP with ulceration treated in Eye Clinic, Clinical Center Nis.
Methods
MC(F,48),had penetrating keratoplasty surgery 40years before due to penetrating corneal wound. Reffered to ophthalmologist with pain, epiphora.VA left eye:light perception. Conjunctival hyperaemia, opaque cornea with central epithelial and shallow stromal tissue defect stained with fluorescein. Cornea insensitive. In lower half of cornea superfitial and deep neovascularization. Further structure hard to observe. After 3weeks of topical and systemic therapy less conjunctival redness, cornea is more transparent but thick, corneal wound healed, dry epithelium-fluorescein dot stained in central part. Graft infiltrated at borders.
Results
Therapy: ceftriaxone, gentamycin intramuscular and corticosteroid 120mg 7days in addition to moxifloxacin, tobramycin, NaCL 5%, ofloxacin ointment, hyaluronic eye drops according to ulceration protocol. One week after continuous per hour antibiotic, stromal defect shallowed. Staphyloccocus epidermidis isolated in conjunctival swab. B scan showed rare vitreal opacification. Wound healed after 3 weeks.
Conclusion
Case presents corneal graft complication due to neurotrophic condition and bacterial superinfection that complicated with ulceration. Also graft rejection and endophthalmitis was observed diferentialy in diagnostics, but not confirmed. Good medicine response resulted in fast resolution and healing.