Vernal keratokonjonktivitte non-travmatik non-enfeksiyöz spontan kornea perforasyonu nedeniyle limbal allogreft ve tektonik keratoplasti uygulaması
Abstract
Bilateral vernal keratokonjonktivitli bir hastada, non-travmatik ve non-enfeksiyöz spontan kornea perforasyonu nedeniyle tektonik keratoplasti ve limbal allogreft uygulamasını ortaya koymaktır.
Bilateral vernal keratokonjonktivit ve eşlik eden limbal kök hücre yetmezliği olan 27 yaşındaki erkek hasta; sağ gözde kızarıklık, fotofobi ve sekresyon artışı şikayeti ile kliniğimize başvurdu. En iyi düzeltilmiş görme keskinliği (EİDGK) sağ gözde 20/640 ve sol gözde 20/33 düzeyindeydi. Biyomikroskobik muayenede limbal kök hücre yetmezliğine bağlı bilateral korneal vaskülarizasyon ve sağ gözde parasantral inferior temporal yerleşimli 1,5 mm’lik perforasyon alanı mevcuttu. Konservatif tedavinin başarısız olması nedeniyle hastaya limbal allogreft ile eş zamanlı tektonik amaçlı keratoplasti cerrahisi uygulandı.
Postoperatif 2. ayda hasta kızarıklık, ağrı ve bulanık görme şikayeti ile başvurdu. Korneal greftte ödem ve keratik prespitatlar tespit edildi. Allogreft reddi gelişen hastaya subkonjonktival ve topikal yüksek doz steroid tedavisi başlandı. Tedaviden 1 ay sonra, allogreft red reaksiyonunun gerilediği ve sağ gözde EİDGK’nin 20/125 düzeyinde olduğu görüldü. Postoperatif 18 aylık takip süresince hastanın klinik durumunun stabil olduğu izlendi. Vernal keratokonjonktivite bağlı gelişen limbal kök hücre yetmezliği zemininde ortaya çıkan non-travmatik ve non-enfeksiyöz kornea perforasyonunda limbal allogreft ile eş zamanlı tektonik keratoplasti etkin ve güvenli bir tedavi seçeneğidir. Bununla birlikte bu olgularda red reaksiyonu ihtimalinin yüksek olabileceği akılda tutulmalıdır. Hasta ve yakınlarının bilgilendirilmesi ile kızarıklık, ağrı, bulanık görme gibi olası red reaksiyonu semptomları varlığında erken başvuru yapmalarının sağlanması, red reaksiyonlarının tedavi edilebilmesinde faydalı olacaktır.
Keywords
Vernal keratokonjonktivit non-travmatik ve non-enfeksiyöz korneal perforasyon limbal allogreft tektonik keratoplasti
References
- Bonini S, Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zuccaro O, Rama P, Magrini L, Juhas T, Bucci MG. Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term follow up. Ophthalmology. 2000 Jun; 107 (6): 1157-63.
- Buckley RJ. Verna lkeratoconjunctivitis. Int Ophthalmol Clin. 1988 Winter; 28 (4): 303-8.
- Fukuda K, Nishida T. Ocular allergic inflammation: interaction between the cornea and conjunctiva. Cornea, 2010; 29: 62–7.
- Saboo US, Jain M, Reddy JC, Sangwan VS. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India. Indian J Ophthalmol, 2013; 61 (9): 486–9.
- Nivenius E, Montan P. Spontaneous corneal perforation associated with atopic keratoconjunctivitis: a case series and literature review. Acta Ophthalmol. 2015 Jun; 93 (4): 383-7.
- Foster CS, Calonge M. Atopic keratoconjunctivitis. Ophthalmology. 1990 Aug; 97 (8): 992-1000.
- Kumagai N, Yamamoto K, Fukuda K, Nakamura Y, Fujitsu Y, Nuno Y, Nishida T. Active matrix metalloproteinases in the tear fluid of individuals with vernal keratoconjunctivitis. J Allergy Clin Immunol. 2002 Sep; 110 (3): 489-91.
- Aldave AJ, Mabon M, Hollander DA, McLeod SD, Spencer WH, Abbott RL. Spontaneous corneal hydrops and perforation in keratoconus and pellucid marginal degeneration. Cornea. 2003 Mar; 22 (2): 169-74.
- Yokogawa H, Kobayashi A, Yamazaki N, Masaki T, Sugiyama K. Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital. Clin Ophthalmol. 2014 Oct 29; 8: 2165-70.
- Hossain P, Tourkmani AK, Kazakos D,Jones M, Anderson D. Emergency corneal grafting in the UK: a 6 – year analysis of the UK Transplant Registry. Br J Ophthalmol. 2018; 102 (1): 26-30.
Tectonic keratoplasty with limbal allograft transplantation in non-traumatic, non-infectious corneal perforation associated with vernal keratoconjunctivitis
Abstract
To report the management of non-traumatic, non-infectious corneal perforation with limbal allograft transplantation and tectonic keratoplasty in a patient with bilateral vernal keratoconjunctivitis.
A 27-year-old male with bilateral vernal keratoconjunctivitis with accompanying limbal stem cell deficiency presented with redness, photophobia and discharge in the right eye. Best corrected visual acuity (BCVA) was 20/640 OD and 20/33 OS. Slit-lamp examination revealed bilateral corneal vascularization due to limbal stem cell deficiency and a 1.5 mm perforation at the paracentral lower temporal cornea of the right eye. Conservative treatment was unsuccessful. Therefore, tectonic keratoplasty with limbal allograft transplantation was performed. Two months later, the patient admitted to the hospital with redness, pain and blurry visual deterioration in the affected eye. Corneal graft was edematous and keratic precipitates on the corneal graft were evident. The patient was diagnosed as corneal allograft rejection and subconjunctival and topical intensive steroid treatment were initiated. One month after treatment, allograft rejection regressed, BCVA was measured as 20/125 OD. He is still stable for 18 months.
Keratoplasty combined with limbal allograft transplantation is one of the treatment options in patients with corneal perforation secondary to vernal keratoconjunctivitis accompanying with limbal stem cell deficiency. In these cases, the possibility of allograft rejection should be kept in mind. Patients and their relatives should be informed about the procedure and encourage to admit in any case of redness, pain or visual impairment in order to manage the rejection and provide a prolonged graft survival.
Keywords
Vernal keratoconjunctivitis non-traumatic non-infectious corneal perforation limbal allograft transplantation tectonic keratoplasty
References
- Bonini S, Bonini S, Lambiase A, Marchi S, Pasqualetti P, Zuccaro O, Rama P, Magrini L, Juhas T, Bucci MG. Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term follow up. Ophthalmology. 2000 Jun; 107 (6): 1157-63.
- Buckley RJ. Verna lkeratoconjunctivitis. Int Ophthalmol Clin. 1988 Winter; 28 (4): 303-8.
- Fukuda K, Nishida T. Ocular allergic inflammation: interaction between the cornea and conjunctiva. Cornea, 2010; 29: 62–7.
- Saboo US, Jain M, Reddy JC, Sangwan VS. Demographic and clinical profile of vernal keratoconjunctivitis at a tertiary eye care center in India. Indian J Ophthalmol, 2013; 61 (9): 486–9.
- Nivenius E, Montan P. Spontaneous corneal perforation associated with atopic keratoconjunctivitis: a case series and literature review. Acta Ophthalmol. 2015 Jun; 93 (4): 383-7.
- Foster CS, Calonge M. Atopic keratoconjunctivitis. Ophthalmology. 1990 Aug; 97 (8): 992-1000.
- Kumagai N, Yamamoto K, Fukuda K, Nakamura Y, Fujitsu Y, Nuno Y, Nishida T. Active matrix metalloproteinases in the tear fluid of individuals with vernal keratoconjunctivitis. J Allergy Clin Immunol. 2002 Sep; 110 (3): 489-91.
- Aldave AJ, Mabon M, Hollander DA, McLeod SD, Spencer WH, Abbott RL. Spontaneous corneal hydrops and perforation in keratoconus and pellucid marginal degeneration. Cornea. 2003 Mar; 22 (2): 169-74.
- Yokogawa H, Kobayashi A, Yamazaki N, Masaki T, Sugiyama K. Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital. Clin Ophthalmol. 2014 Oct 29; 8: 2165-70.
- Hossain P, Tourkmani AK, Kazakos D,Jones M, Anderson D. Emergency corneal grafting in the UK: a 6 – year analysis of the UK Transplant Registry. Br J Ophthalmol. 2018; 102 (1): 26-30.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | March 31, 2021 |
| Submission Date | November 28, 2019 |
| Published in Issue | Year 2021 |