Posters

Granulomatous lamellar keratitis secondary to atypical mycobacteriae in deep anterior lamellar keratoplasty (DALK): a new clinical presentation

Poster Details

First Author: M. Calatayud SPAIN

Co Author(s):    S. Martin   J. Puig   L. Bisbe              

Abstract Details

Purpose:

To describe a new clinical form of lamellar keratitis in a patient with a previous DALK due to spontaneous crystalline keratopathy.

Setting:

Vall d´Hebron Hospitals, Cornea and Ocular Surface Unit, Barcelona,Spain.

Methods:

a patient with a traumatic corneal injury in his only one eye was referred for a second opinion because the presence of an persistent epithelial defect and lack of response to usual treatment. Cultures were negative for common germs. The patient developed very quickly a spontaneous crystalline keratopathy close to perforation, so we performed a deep anterior lamellar keratoplasty (DALK) with immediate improvement. One week after the surgery atypical mycobacteria growed in the culture, and the anterior segment examination showed micro-nodules located at the interface with a quiet eye.

Results:

Given the quick progression of the disease, a penetrating keratoplasty (PK) was performed.Pathology showed multiple pseudogranulomatous lesions located over the predescemetic stroma of the recipient. One year after PK, the patient needed cataract surgery, the eye is quiet and the best corrected visual acuity is 20/40.

Conclusions:

Lamellar keratitis may also occur as microgranulomas at the interface of a lamellar graft in cases caused by atypical pathogens with a slow creeping growth. The ophthalmologist must be aware of this possibility in cases with atypical evolution. In this cases penetrating keratoplasty should be considered instead of lamellar procedures as a definitive therapy.

Financial Disclosure:

NONE