Case Reports

Post-traumatic neurotrophic keratopathy as a cause of diagnostic and therapeutic difficulties in cataract surgery

Case Report Details

First Author: E.Mrukwa-Kominek POLAND

Co Author(s):    M. Sarnat-Kucharczyk   W. Lubon   K. Jadczyk-Sorek              

Abstract Details

Purpose:

Neurotrophic keratitis is a very uncommon reported complication of communication trauma. The aim of the study is to present diagnostic and therapeutic difficulties in patient after severe trauma in whom not responding to local treatment corneal clouding make difficult cataract surgery

Setting:

1 Department of Ophthalmology, Medical University of Silesia, Katowice,Poland 2 Department of Ophthalmology, Professor K. Gibinski University Clinical Center of the Medical University of Silesia, Katowice, Poland

Report of Case:

A 26-year-old patient suffered a communication injury, which resulted in fracture of the eye socket bones, intussusception of the temporal bone pyramid and damage to the trigeminal ganglion. This, in turn, led to the development of ophthalmic complications as : incomplete closure of the eyelids, disruption of tear secretion and the development of severe dry eye and neurotrophic keratitis. Authors present the difficulties in the management of corneal lesion. Within 9 months, post-traumatic intumescent cataract developed, which was accompanied by an increase in intraocular pressure. An additional obstacle in controlling the ophthalmic state was the critical general condition of the patient who remained in a coma. The resulting intumescent cataract, visual acuity decreased to light perception with the correct location, increased intraocular pressure of up to 30 mmHg. Despite the reduced transparency of the cornea, it was decided to perform the lens removal procedure, which was extremely difficult. In such cases, the surgeon's experience, the need to modify phacoemulsification parameters and the use of methods to increase intraoperative visualization are important. The procedure was completed with IOL implantation. After the procedure, the patient's visual acuity improved to 0.04 and the intraocular pressure ranged from 12 to 16 mmHg

Conclusion/Take Home Message:

Performing phacoemulsification in patient with high IOP pressure is necessary even in difficult optical conditions. It can be difficult even for an experienced surgeon. Based on the patient's observation, therapeutic dilemmas encountered during the treatment of severe post-traumatic ocular complications show that in such cases the standard treatment does not always give a good effect.

Financial Disclosure:

None