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Spontaneous corneal melting in pregnancy: a case report.

Arya SK, Malik A, Gupta S, Gupta H, Sood S - J Med Case Rep (2007)

Bottom Line: She was managed conservatively with cyanoacrylate glue, bandage contact lens, lubricants and antibiotics.It may not always be possible to find the underlying cause of corneal melting but the more common underlying causes should be ruled out by proper investigations.Pregnancy with its host of hormonal changes could potentially have some effect on corneal collagen leading to corneal melting in compromised corneas.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India. drarchanag2002@yahoo.com.

ABSTRACT

Background: To report a case of spontaneous corneal melting in pregnancy. We reviewed the literature on corneal melting and the effect of pregnancy on cornea and collagen containing tissues.

Case presentation: A 29-year-old woman who underwent radial keratotomy in both eyes followed by trabeculectomy in her left eye developed corneal melting in the same eye, in her seventh month of pregnancy. Despite screening, no infectious or immune mediated condition could be identified. She was managed conservatively with cyanoacrylate glue, bandage contact lens, lubricants and antibiotics.

Conclusion: It may not always be possible to find the underlying cause of corneal melting but the more common underlying causes should be ruled out by proper investigations. Pregnancy with its host of hormonal changes could potentially have some effect on corneal collagen leading to corneal melting in compromised corneas.

No MeSH data available.


Related in: MedlinePlus

A and B: Left eye showing central corneal melting with perforation inferiorly. C: Cyanoacrylate glue and bandage contact lens applied. D: Healed stage with leucomatous corneal opacity.
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Figure 2: A and B: Left eye showing central corneal melting with perforation inferiorly. C: Cyanoacrylate glue and bandage contact lens applied. D: Healed stage with leucomatous corneal opacity.

Mentions: A 29-year old woman who was in her seventh month of pregnancy presented with chief complaints of sudden onset of pain and watering in her left eye of 4 days duration. Her past history revealed the onset of myopia at the age of 12 years which gradually increased and stabilized by 18 years of age. At the age of 20 years she underwent radial keratotomy in both eyes for myopic correction. She developed secondary angle closure glaucoma in left eye following radial keratotomy (probably there was microperforation at the time of radial keratotomy, leading to shallow anterior chamber with formation of peripheral anterior synechiae leading to raised IOP) for which she underwent glaucoma filtering surgery without Mitomycin C elsewhere 8 months later. Records revealed IOP of less than 21 mmHg till few months postoperatively. A year later, she presented to us with a painful eye which on examination revealed flat anterior chamber in the periphery and very shallow centrally (Fig. 1). The intraocular pressure as measured by applanation tonometer was 40 mmHg and her vision was light perception with inaccurate projection of rays. Posterior segment examination revealed glaucomatous optic atrophy in left eye. Cyclocryotherapy was done after which the intraocular pressure came back to normal. She remained asymptomatic for the next few years, during which she conceived. The first and second trimesters were uneventful, but during the seventh month of pregnancy she presented with sudden onset of pain, redness and watering but no discharge in the left eye. Examination revealed central corneal melting measuring 6 × 6 mm and an area of corneal perforation inferiorly of approximately 2 × 3 mm. There was mild corneal edema without any evidence of active infiltration and rest of the cornea was clear. Corneal sensations were normal and equally brisk in both eyes. On slit lamp examination, a very thin layer of posterior corneal stroma could be seen in the area of melting. The anterior chamber was flat (Fig. 2a, b). Intraocular pressure was low digitally. Gram and KOH stain and culture on Blood and Sabouraud's dextrose agar were negative. There was no history of trauma or any other systemic illness and the patient did not exhibit any clinical features of systemic vasculitis or autoimmune condition. Rheumatoid factor, antinuclear antibody, anti-cytoplasmic and anti-DNA antibodies were negative. Patient had not used any topical drops during the intervening period. The vision in her right eye was 6/6 with -1.50 Diopters and the examination was essentially unremarkable. The patient being in the late stage of pregnancy and having a poor visual prognosis, conservative management was planned. Cyanoacrylate glue and bandage contact lens were applied and topical antibiotics, cycloplegics and lubricating drops were prescribed (Fig. 2c). After 3 weeks of conservative treatment, corneal edema decreased and corneal perforation gradually healed. Anterior chamber remained flat, although the intraocular pressure was normal digitally. She was kept on regular follow up and on her last visit; leucomatous corneal opacity was seen at the involved site (Fig. 2d).


Spontaneous corneal melting in pregnancy: a case report.

Arya SK, Malik A, Gupta S, Gupta H, Sood S - J Med Case Rep (2007)

A and B: Left eye showing central corneal melting with perforation inferiorly. C: Cyanoacrylate glue and bandage contact lens applied. D: Healed stage with leucomatous corneal opacity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2194706&req=5

Figure 2: A and B: Left eye showing central corneal melting with perforation inferiorly. C: Cyanoacrylate glue and bandage contact lens applied. D: Healed stage with leucomatous corneal opacity.
Mentions: A 29-year old woman who was in her seventh month of pregnancy presented with chief complaints of sudden onset of pain and watering in her left eye of 4 days duration. Her past history revealed the onset of myopia at the age of 12 years which gradually increased and stabilized by 18 years of age. At the age of 20 years she underwent radial keratotomy in both eyes for myopic correction. She developed secondary angle closure glaucoma in left eye following radial keratotomy (probably there was microperforation at the time of radial keratotomy, leading to shallow anterior chamber with formation of peripheral anterior synechiae leading to raised IOP) for which she underwent glaucoma filtering surgery without Mitomycin C elsewhere 8 months later. Records revealed IOP of less than 21 mmHg till few months postoperatively. A year later, she presented to us with a painful eye which on examination revealed flat anterior chamber in the periphery and very shallow centrally (Fig. 1). The intraocular pressure as measured by applanation tonometer was 40 mmHg and her vision was light perception with inaccurate projection of rays. Posterior segment examination revealed glaucomatous optic atrophy in left eye. Cyclocryotherapy was done after which the intraocular pressure came back to normal. She remained asymptomatic for the next few years, during which she conceived. The first and second trimesters were uneventful, but during the seventh month of pregnancy she presented with sudden onset of pain, redness and watering but no discharge in the left eye. Examination revealed central corneal melting measuring 6 × 6 mm and an area of corneal perforation inferiorly of approximately 2 × 3 mm. There was mild corneal edema without any evidence of active infiltration and rest of the cornea was clear. Corneal sensations were normal and equally brisk in both eyes. On slit lamp examination, a very thin layer of posterior corneal stroma could be seen in the area of melting. The anterior chamber was flat (Fig. 2a, b). Intraocular pressure was low digitally. Gram and KOH stain and culture on Blood and Sabouraud's dextrose agar were negative. There was no history of trauma or any other systemic illness and the patient did not exhibit any clinical features of systemic vasculitis or autoimmune condition. Rheumatoid factor, antinuclear antibody, anti-cytoplasmic and anti-DNA antibodies were negative. Patient had not used any topical drops during the intervening period. The vision in her right eye was 6/6 with -1.50 Diopters and the examination was essentially unremarkable. The patient being in the late stage of pregnancy and having a poor visual prognosis, conservative management was planned. Cyanoacrylate glue and bandage contact lens were applied and topical antibiotics, cycloplegics and lubricating drops were prescribed (Fig. 2c). After 3 weeks of conservative treatment, corneal edema decreased and corneal perforation gradually healed. Anterior chamber remained flat, although the intraocular pressure was normal digitally. She was kept on regular follow up and on her last visit; leucomatous corneal opacity was seen at the involved site (Fig. 2d).

Bottom Line: She was managed conservatively with cyanoacrylate glue, bandage contact lens, lubricants and antibiotics.It may not always be possible to find the underlying cause of corneal melting but the more common underlying causes should be ruled out by proper investigations.Pregnancy with its host of hormonal changes could potentially have some effect on corneal collagen leading to corneal melting in compromised corneas.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India. drarchanag2002@yahoo.com.

ABSTRACT

Background: To report a case of spontaneous corneal melting in pregnancy. We reviewed the literature on corneal melting and the effect of pregnancy on cornea and collagen containing tissues.

Case presentation: A 29-year-old woman who underwent radial keratotomy in both eyes followed by trabeculectomy in her left eye developed corneal melting in the same eye, in her seventh month of pregnancy. Despite screening, no infectious or immune mediated condition could be identified. She was managed conservatively with cyanoacrylate glue, bandage contact lens, lubricants and antibiotics.

Conclusion: It may not always be possible to find the underlying cause of corneal melting but the more common underlying causes should be ruled out by proper investigations. Pregnancy with its host of hormonal changes could potentially have some effect on corneal collagen leading to corneal melting in compromised corneas.

No MeSH data available.


Related in: MedlinePlus