Case Report
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A case of peripheral ulcerative keratitis after cross-linking for keratoconus

Year 2016, , 218 - 221, 01.12.2016
https://doi.org/10.21601/ortadogutipdergisi.272675

Abstract

We aimed to introduce a
case of peripheral ulcerative keratitis occuring after cross-linking for the
treatment of keratoconus in this study. A female diabetic patient, 38 year-old,
was admitted to our clinic in September 2011. Her cycloplegic refraction was
-1.00 -3.75 48 in her right eye and -2.00 -4.50 144 in her left eye. Her visual
acuity was 0.4/ 0.1 with and without correction. Her keratometry was measured
as  46.12 50.62 139 in her right eye and
46.75 53.62 54 in her left eye. After 17 months she was admitted to our clinic
again and she gave a history of cross-linking in her both eyes 3 weeks ago. The
patient complained of pain, blurry vision and hyperemia in her both eyes. She
had been treated with antibiotic drops, artificial tears, corticosteroid drops
and contact lenses for 4 monthts, but no improvement could be recorded. In
contrast epithelial defects, infiltrates and thinning were detected in the
periphery of both corneas. Because the systemic steroids caused dysregulation
of blood glucose level, Azathioprine was preferred. Pathologic findings
ameliorated with this drug, but it had to be stopped because of economical
reasons. The complaints recur sometimes and are treated with topical drugs. The
patient stil has a ring opacity in her both eyes. The doctors interested in the
cross-linking treatment of keratoconus should be careful about the diabetes
mellitus. If peripheral ulcerative keratitis is detected in such a case it can
be treated with systemic immune suppressive drugs.

References

  • Dhawan S, Kao K, Natrajan S. Complications of corneal collagen cross-linking. J Ophthalmol. 2011; 2011: 869015.
  • Seiler TG, Schmidinger G, Fischinger I, Koller T, Seiler T. Complications of cross-linking. Ophthalmologe. 2013; 110: 639-44.
  • Angunawela RI, Arnalich-Montiel F, Allan BD. Peripheral sterile corneal infiltrates and melting after collagen crosslinking for keratoconus. J Cataract Refract Surg. 2009; 35: 606-7.
  • Mangioris GF, Papadopoulou DN, Balidis MO, Poulas JL, Papadopoulos NT, Seiler T. Corneal infiltrates after corneal collagen cross-linking. J Refract Surg. 2010; 26: 609-11.
  • Bagga B, Pahuja S, Murthy S, Sangwan VS. Endothelial failure after collagen cross-linking with riboflavin and UV-A: case report with literature review. Cornea 2012; 31: 1197-200.
  • Sharma A, Nottage JM, Mirchia K, Sharma R, Mohan K, Nirankari VS. Persistent corneal edema after collagen cross-linking for keratoconus. Am J Ophthalmol. 2012; 154: 922-926.
  • Ferrari G, Iuliano L, Vigano M, Rama P. Impending corneal perforation after collagen cross-linking for herpetic keratitis. J Cataract Refract Surg. 2013; 39: 638-41.
  • Galor A, Thorne JE. Scleritis and peripheral ulcerative keratitis. Rheum Dis Clin North Am. 2007; 33: 835-854.
  • Yagci A. Update on peripheral ulcerative keratitis. Clin Ophthalmol. 2012; 6: 747-754.
  • Utine CA, Çakır H, Altunsoy M. Korneanın ektatik hastalıklarının tedavisinde kollajen çapraz bağlama. T. Oft Gaz. 2009; 39: 153-160.

Keratokonus nedeniyle çapraz bağlama yapılan olguda periferik ülseratif keratit

Year 2016, , 218 - 221, 01.12.2016
https://doi.org/10.21601/ortadogutipdergisi.272675

Abstract

Bu çalışmada keratokonus
tedavisi amacıyla çapraz bağlama uygulanan bir olguda meydana gelen periferik
ülseratif keratitin sunulması amaçlanmıştır. Eylül 2011'de kliniğimize müracaat
ettiği sırada 38 yaşında olan diyabetes mellituslu kadın hastanın yapılan
muayenesinde sikloplejik otorefraktometre değerleri sağ gözde -1,00 -3,75 48,
sol gözde -2,00 -4,50 144 olarak tespit edildi. Keratometri değerleri ise sağ
gözde 46,12 50,62 139, sol gözde 46,75 53,62 54 idi. Görme düzeyleri 0,4/ 0,1
düzeyinde olup tashihle artmadı. Keratokonus tanısı konulan hasta 17 ay sonra
başka bir klinikte çapraz bağlama uygulanmış olarak kliniğimize müracaat etti.
Hastanın gözlerinde ağrı, bulanık görme ve kanlanma şikayetleri mevcuttu. 4 ay
boyunca antibiyotik, suni gözyaşı, kortizon içerikli damlalar ve kontakt
lenslerle takip edilen hastanın şikayetlerinde düzelme olmadı. Aksine her iki
gözde kornea çevresel kısmında halka tarzında epitel defekti, infiltrat ve
incelme ortaya çıktı. Sistemik steroid tedavisiyle kan şekeri kontrolü
bozulması üzerine Azathioprine ilacına geçildi. Bu şekilde bulguları kontrol
altına alınan hastada ekonomik sorunlar nedeniyle bir süre sonra Azathioprine
kesildi. İki gözde halka tarzında kesafeti devam eden hastanın ataklar halinde
şikayetleri olmasına rağmen topikal tedavilerle kontrol altında kalması
sağlandı. Özellikle diyabetes mellitusu olan hastalarda keratokonus tedavisi
amacıyla çapraz bağlama yapılırken dikkatli olunmalı, böyle bir tablo ortaya
çıktığı takdirde sistemik immün supresif ilaçlarla tedavi edilebileceği akılda
tutulmalıdır.



References

  • Dhawan S, Kao K, Natrajan S. Complications of corneal collagen cross-linking. J Ophthalmol. 2011; 2011: 869015.
  • Seiler TG, Schmidinger G, Fischinger I, Koller T, Seiler T. Complications of cross-linking. Ophthalmologe. 2013; 110: 639-44.
  • Angunawela RI, Arnalich-Montiel F, Allan BD. Peripheral sterile corneal infiltrates and melting after collagen crosslinking for keratoconus. J Cataract Refract Surg. 2009; 35: 606-7.
  • Mangioris GF, Papadopoulou DN, Balidis MO, Poulas JL, Papadopoulos NT, Seiler T. Corneal infiltrates after corneal collagen cross-linking. J Refract Surg. 2010; 26: 609-11.
  • Bagga B, Pahuja S, Murthy S, Sangwan VS. Endothelial failure after collagen cross-linking with riboflavin and UV-A: case report with literature review. Cornea 2012; 31: 1197-200.
  • Sharma A, Nottage JM, Mirchia K, Sharma R, Mohan K, Nirankari VS. Persistent corneal edema after collagen cross-linking for keratoconus. Am J Ophthalmol. 2012; 154: 922-926.
  • Ferrari G, Iuliano L, Vigano M, Rama P. Impending corneal perforation after collagen cross-linking for herpetic keratitis. J Cataract Refract Surg. 2013; 39: 638-41.
  • Galor A, Thorne JE. Scleritis and peripheral ulcerative keratitis. Rheum Dis Clin North Am. 2007; 33: 835-854.
  • Yagci A. Update on peripheral ulcerative keratitis. Clin Ophthalmol. 2012; 6: 747-754.
  • Utine CA, Çakır H, Altunsoy M. Korneanın ektatik hastalıklarının tedavisinde kollajen çapraz bağlama. T. Oft Gaz. 2009; 39: 153-160.
There are 10 citations in total.

Details

Subjects Health Care Administration
Journal Section Case report
Authors

Ömer Faruk Recep

Publication Date December 1, 2016
Published in Issue Year 2016

Cite

Vancouver Recep ÖF. Keratokonus nedeniyle çapraz bağlama yapılan olguda periferik ülseratif keratit. otd. 2016;8(4):218-21.

e-ISSN: 2548-0251

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