Case Reports

The mysterious shallow chamber: persisting shallow chamber after bevelled full thickness corneal laceration

Case Report Details

First Author: G.Barosco ITALY

Co Author(s):    G. Barosco   C. Chierego   A. Rodella   A. Montresor   E. Pedrotti   G. Marchini     

Abstract Details

Purpose:

To share the diagnostic and therapeutic process as well as visual and anatomical outcomes in a patient who experienced a full thickness bevelled edge corneal laceration with persistent shallow chamber and a myopic shift at the follow-up visits.

Setting:

The patient referred to the emergency service of the Eye Clinic of the University of Verona in January 2020. After the first visit all the follow-up visits and the instrumental examinations have been conducted by the same two Doctors (CC; GB).

Report of Case:

The patient was a 44 years old male, in good state of health, without concomitant general pathology as well as eye diseases. He was sent from the general emergency triage to the emergency service of the Eye Clinic referring the decrease of the visual acuity on the right eye after a powerful trauma with the end of an iron wire while he was cutting it without eye protection. He declared on the right eye a monocular uncorrected distance visual acuity (VA) of 20/20 before the trauma; at the visit he performed 20/30 with -0.75 spherical equivalent (SE). Eye exam shown a bevelled corneal full-thickness laceration nearby the limbus from h9 to h12, Seidel negative; anterior chamber (AC) was shallow (shallower than the fellow eye), hematic Tyndall ++/--; fundus examination was negative for any pathological findings; intraocular pressure (IOP) was 12 mmHg. A therapeutic contact lens was placed; medical topical therapy with Cloramfenicol/Dexamethasone 4 times/die and Tropicamide 1% 1 time/day at night was prescribed. 1 week after VA was 20/20 with -2.00 of SE; shallow AC; IOP was 16 mmHg; an ultrasound biomicroscopy (UBM) was performed and showed a peripheral flat suprachoroidal detachment on 360°; B-Scan confirmed the findings; posterior pole was normal; therapy was up-dated with oral Prednisone tablets 50 mg/die; Atropine eye drops 2 times/die; Cloramfenicol/Dexamethasone eye drops 4 times/die. 2 weeks after visual acuity was 20/20 with -1.00 of SE; AC was still shallower than the fellow eye; IOP was 16 mmHg; UBM showed a reduction of the choroidal detachment; Prednisone tablets were progressively tapered in 15 days, than suspended; medical topical therapy with Cloramfenicol/Dexamethasone 3 times/day tapering in 2 weeks and Atropine 2 times/day. 6 weeks later uncorrected visual acuity was 20/20; AC was deep (as deep as the fellow eye); topical therapy was suspended.

Conclusion/Take Home Message:

After an ocular trauma, once ruled out ocular perforation and ocular hypotonia, a shallow AC and a myopic shift must be considered as indirect sings of flat peripheral choroidal detachment. B-scan sonography and UBM are helpful in confirming the diagnosis. Systemic and topical corticosteroids and cycloplegia could be useful in accelerating the recovery.

Financial Disclosure:

None