|Year : 1985 | Volume
| Issue : 5 | Page : 321-322
Sterile corneal perforation after cataract surgery in keratoconus posticus circumscriptus
SK Angra, S Chawdhary
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
S K Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|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 2021 Jan 18];33:321-2. Available from: https://www.ijo.in/text.asp?1985/33/5/321/30740
Central sterile corneal performation following cataract extraction in patients of Sjogren's syndrome, and rheumatoid arthritis is known. A similar outcome, is documented here in a case of keratoconus posticus circumscriptus following operation for cataract.
| Case report|| |
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|| |
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,. 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|| |
Sterile corneal perforation after cataract extraction in a case of keratoconus posticus circumscriptus is documented with discussion on possible pathomechanism.
| References|| |
Cohen, K. L,, 1982, Brit. J. Ophthalmol. 66:179.
Radtke, N., Meyers, S., and Kaufman, H.E. 1978, Arch. Ophthalmol. 96:61.
Mohan, M, Panda, A. and Patnaik, N., Canad. J Ophthalmol (in press).
Wolter, J R., and Haney, W.P., 1963, Arch. Ophthalmol. 69:357.
Krachmer, H H., and Rodrigues, M.M., 1978 Arch. Ophthalmol. 96:1867.
[Figure - 1], [Figure - 2]