|LETTER TO EDITOR
|Year : 2003 | Volume
| Issue : 1 | Page : 105-106
Peripheral ulcerative keratitis after pterygium surgery.
Nikhil S Gokhale
Nikhil S Gokhale
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gokhale NS. Peripheral ulcerative keratitis after pterygium surgery. Indian J Ophthalmol 2003;51:105-6
Possible causes of a localised non-progressive corneal melt or thinning after a pterygium surgery include a very deep dissection, a dellen effect, delayed corneal epithelisation or infection of the corneal bed. Mooren's ulcer , has been reported after ocular surgery. A cellular and humoral response to corneal antigens  has been demonstrated in these patients. Other forms of peripheral ulcerative keratitis (PUK) is also a rare possibility. These eyes usually do not have severe pain. This rare complication can occur after any corneal surgery, due to an immune response to altered corneal antigens triggered by the surgical trauma. We illustrate one such case.
A 28-year-old female presented with a history of repeated episodes of pain, redness and watering in her left eye for six months. She had undergone a pterygium surgery in the left eye six months ago. The details of the surgical technique or the use of Mitomycin-C was not mentioned. Postoperatively progressive peripheral corneal thinning was noted and despite treatment with topical corticosteroids, antibiotics and lubricants, she continued to worsen.
On examination her right eye was within normal limits. The left eye had a vision of 6/18 and showed diffuse congestion more in the nasal quadrant, and a peripheral ulcerative keratitis (PUK) extending from 7 to 11' o clock position. The superior and inferior edges of the ulcer showed activity with stromal infiltration and an epithelial defect staining with fluoroscein. The central part of the crater was thin but epithelised. There was no scleral involvement. Lens was clear and fundus was normal.
Systemic evaluation by a physician and results of investigations including haemogram with erythrocyte sedimentation rate (ESR), rheumatoid factor, antinuclear antibody, chest X ray, renal and liver function tests were within normal limits.
The patient was started on oral prednisolone 1 mg / kg/day, oral nimesulide 100 mg twice a day, topical ciprofloxacin 0.3%, dexamethasone 0.1% and carboxymethylcellulose 0.5% eye drops four times each in the left eye. After 10 days of treatment the ulcer continued to progress peripherally and extended from 6:30 to 11:30 clock hours [Figure - 1]. The patient then underwent a conjunctival resection, debridement, cyanoacrylate glue application and a bandage lens application under local anaesthesia. Conjunctiva was resected extending about 2 clock hours beyond the active edge on both sides and up to 4 mm from the limbus. The infiltrated active edge was debrided and glue applied over the thinned area. The medical treatment was continued as prior. The patient improved with relief of pain and redness. The oral prednisolone was tapered slowly over a period of two months and stopped. The glue and contact lens were removed after three months. Ciprofloxacin 0.3% and dexamethasone 0.1% eye drops were tapered after glue removal and stopped a month later. The patient was continued on carboxymethylcellulose 0.5% eye drops four times a day. Six months after glue removal the patient has a quiet eye with a vascularised corneal scar and no active inflammation [Figure - 2].
| References|| |
Sangwan VS, Zafirakis P, Foster CS. Mooren's ulcer: Current concepts in management. Indian J Ophthamol
Mondino BJ, Hofbauer JD, Foos RY. Mooren's ulcer after penetrating keratoplasty. Am J Ophthalmol
Gottsch JD, Liu SH, Minkovitz JB, Goodman DF, Srinivasan M, Stark WJ. Autoimmunity to a cornea associated stromal antigen in patients with Mooren's ulcer. Invest Ophthalmol Vis Sci
[Figure - 1], [Figure - 2]