Posters

Corneal perforation with vision loss after pterygium exeresis: a case report

Poster Details

First Author: B.Nazareth Parize Clemente BRAZIL

Co Author(s):    N. Bahjat Hajj   C. Alberto Pinto   A. Chater Taleb   C. Maria Carossa Veiga Jardim           

Abstract Details

Purpose:

To describe a rare case of corneal perforation after pterygium exeresis with subsequent vision loss, focusing on the treatment and discussion of the surgical technique.

Setting:

Hospital de Olhos Aparecida (HOA) at Aparecida de Goiânia, Goiás, Brazil.

Methods:

A 42-year-old male patient, with no comorbidities, with best correctedvisual acuity  (BCVA) 20/20 (1,0) in both eyes evolved with severe pain and worsened visual acuity after pterigeous exertion in the left eye 4 days after surgery. Visual acuity was counter fingers (CD), and iris-buffered nasal perforation was identified, with normal fundoscopy and IOP: 17 mmHg. On the same day, he underwent a tectonic transplantation with a scleral patch, with graft rejection by infection. Two other tectonic transplants were performed without success.

Results:

Cultures have been negative for bacteria and fungi. However, biomicroscopy was jeopardized by satelite lesions, suggesting fungal infection.Two weeks later, the patient was submitted to the third tectonic transplant, again scleral corneum, with slight improvement of vision and total relief of pain and new material harvested, this time evidencing the growth of Candida sp being maintained the topical amphotericin B. One month after grafting, the patient evolved with new tissue rejection, with no pain complaints and visual acuity of light perception. At the moment it maintains the picture, without pain, waiting for new transplant, and in use of ocular lubricant.

Conclusions:

To our knowledge, this is the second case reported in the corneal perforation literature as a complication of pterygium excision using the technique of naked sclera. The first case was reported in 2015 by Goméz et al in a 60-year-old man with diabetes mellitus using the naked sclera.The perforation was successfully treated by lamellar keratoplasty associated with topical antibiotics. In the case reported by us, the patient did not have any co-morbidities representing a worse prognosis for the treatment, and even so, he evolved with the need for three tectonic transplants, all of which were rejected.

Financial Disclosure:

None