Case Reports

Blindness is not the end

Case Report Details

First Author: M.Puzo SPAIN

Co Author(s):    C. Porcar Plana   J. Sanchez Monroy   M. Romero Sanz   L. Arias Campo   M. Bakkali El Bakkali   F. Bartol-Puyal     

Abstract Details

Purpose:

To describe a case of a 70-year-old male patient diagnosed with retinitis pigmentosa (RP) who attended the emergency department (ED) with pain and redness in his right eye (OD) of several weeks of evolution.

Setting:

Ophthalmology department, Hospital Universitario Miguel Servet, Zaragoza, Spain.

Report of Case:

As personal history, a diagnosis of retinitis pigmentosa stood out, with light perception (LP) in both eyes (OU) since 2012. He also had a subluxation of the intraocular sac-lens complex in OD observed in a routine control in 2014, discarding then surgical intervention due to the null visual improvement expected. Controls were then suspended. In the ED, anterior pole (AP) examination and intraocular pressure (IOP) of his left eye (OS) did not show any notable changes. In his OD, he had severe corneal edema with folds in Descemet’s membrane and intense subepithelial edema. A complete anterior dislocation of the sac-IOL complex associated with a narrow anterior chamber (AC) was also observed, with anterior iridian synechiae that covered the corneal periphery almost entirely. IOP in that eye was slightly elevated (22 mmHg). Medical treatment with therapeutic contact lens (LCT), Tobradex and anti-edema eye drops was prescribed. One week later, IOP had increased to 36 mmHg. It was then decided to surgically intervene the patient, performing pars plana vitrectomy and extraction of the sac-IOL complex. After surgery, the patient reported an improvement of the symptoms. AP examination showed no post-surgical complications, however, severe corneal edema remained, with great epithelial irregularity. IOP was also still elevated. Fundus examination (FE) did not show acute alterations. Treatment with LCT, Tobradex, Antiedema, acetazolamide and potassium were prescribed. On the next visit, AP examination presented better appearance, with less corneal edema, although with an epithelium that remained unstructured. IOP dropped to 6 mmHg, therefor acetazolamide and potassium were discontinued, continuing topical treatments. One week later, the examination remained the same, with controlled IOP (12 mmHg) and an irregular corneal epithelium that produced no symptoms thanks to the LCT. The patient continued with regular controls every 2 months, maintaining good control of his symptoms.

Conclusion/Take Home Message:

We face a singular case, in which due to multiple factors, the patient developed a painful blind eye. On this occasion, thanks to surgery we were able to reverse painful symptoms, giving a better quality of life to the patient. However, this case report reminds us that it is important to assess the ophthalmological patient beyond his VA, since we could probably have prevented the development of the corneal damage. It is important for a patient like the one described to continue under ophthalmological follow-up due to the risk of complications that may arise.

Financial Disclosure:

None