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ARTICLES
Year : 1985  |  Volume : 33  |  Issue : 5  |  Page : 321-322

Sterile corneal perforation after cataract surgery in keratoconus posticus circumscriptus


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
S K Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


PMID: 3843344

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How to cite this article:
Angra S K, Chawdhary S. Sterile corneal perforation after cataract surgery in keratoconus posticus circumscriptus. Indian J Ophthalmol 1985;33:321-2

How to cite this URL:
Angra S K, Chawdhary S. Sterile corneal perforation after cataract surgery in keratoconus posticus circumscriptus. Indian J Ophthalmol [serial online] 1985 [cited 2020 Jul 10];33:321-2. Available from: http://www.ijo.in/text.asp?1985/33/5/321/30740

Central sterile corneal performation follo­wing cataract extraction in patients of Sjogren's syndrome[1],[2] and rheumatoid arthri­tis[3] is known. A similar outcome, is docu­mented here in a case of keratoconus posticus circumscriptus following operation for cataract.


  Case report Top


A 65 year-old-female with bilateral cataracts was found having an axial nebula in the right cornea associated with a correspon­ding localised increase of the posterior corneal curvature [Figure - 1]. The central cornea was only 0.34 mm by Haag Streit 900 pachymeter. The anterior corneal curvature had a slight anterior protrusion in the area of corneal thinning. Guttate changes were seen in the endothelium around the edges of the cone. The left cornea was normal. A diagnosis of keratoconus posticus circumscriptus RE was made. Cryoextraction of the right lens was complicated by vitreous loss which was managed by open sky vitrectomy and a com­plete iridectomy. The patient was receiving antibiotic drops and 1:10 dilated soluble corticosteioid drops four time a day. Two weeks after surgery the patient reported with frequent attacks of sharp shooting pain in the operated eye for last 3 days, where­upon central corneal oedema with vitreo­corneal touch along with an overlying epithelial defect was seen. Intraocular pressure (lOP) was 28mm Hg by pneumoto­nometer. Systemic hyperosmotic therapy retracted the vitreous face partially and nor­malized the IOP. However, 24 hours later a small central corneal perforation with shallow anterior chamber was seen with minimal inflammatory signs [Figure - 2]. Soft lens application reformed the anterior chamber within 24 hours. One week later soft lens was removed as the chamber was well formed and ulceration had healed. Repeated cultu­res were negative for pathogens. Six months later, the vitreous was still in the anterior chamber but without corneal touch. Corrected visual acuity was 6/18.


  Discussion Top


Vitreous touch is disastrous to be corneal endothelium, more so to a pathological or decompensated one. In keratoconus posticus circumscriptus, guttate changes in the endo­thelium and alterations in the Descemet's membrane akin to those in Fuch's dystrophy in the area of thinning are established facts[1],[2]. Evidence of localised endothelial failuer manifesting as stromal and epithelial oedema with bullae formation in the area of corneal thinning was present in our case. Possibly, the endothelial decompensation was caused by vitreous touch and raised IOP caused aseptic perforation in a weak thin zone. Our case was never on full strength dose of corticosteroid drops, thus cannot be blam­med for this aseptic perforation. Hence, additional precautions to prevent vitreous loss and high IOP are recommended while planning cataract extraction in cases of kera­toconus posticus circumscriptus.


  Summary Top


Sterile corneal perforation after cataract extraction in a case of keratoconus posticus circumscriptus is documented with discussion on possible pathomechanism[5].

 
  References Top

1.
Cohen, K. L,, 1982, Brit. J. Ophthalmol. 66:179.  Back to cited text no. 1
    
2.
Radtke, N., Meyers, S., and Kaufman, H.E. 1978, Arch. Ophthalmol. 96:61.  Back to cited text no. 2
    
3.
Mohan, M, Panda, A. and Patnaik, N., Canad. J Ophthalmol (in press).  Back to cited text no. 3
    
4.
Wolter, J R., and Haney, W.P., 1963, Arch. Ophthalmol. 69:357.  Back to cited text no. 4
    
5.
Krachmer, H H., and Rodrigues, M.M., 1978 Arch. Ophthalmol. 96:1867.  Back to cited text no. 5
    


    Figures

  [Figure - 1], [Figure - 2]



 

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