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Tectonic penetrating keratoplasty in a patient with ichthyosis

Poster Details


First Author: N.Rybarova CZECH REPUBLIC

Co Author(s): M. Zemanova   P. Hornackova   M. Michalec   D. Vyslouzilova   E. Vlkova   H. Doskova     

Abstract Details

Purpose:

to report a case of an adult patient with congenital ichthyosis, who presented with severe fungal keratouveitis and corneal melting of a right eye.

Setting:

Ophthalmology Clinic of University Hospital, Brno, Czech Republic

Methods:

case study

Results:

47-years old man with congenital ichthyosis was referred to emergency unit for keratouveitis of the right eye with corneal melting, descemetocele formation and hypopyon. Bilateral cicatrical ectropium and severe fimosis of eyelid aperture was present. Patient underwent triple procedure: tectonic penetrating keratoplasty with cataract extraction and IOL in general anesthesia without complications. Due to a positive fungal cultivation for Candida species, patient was treated with systemic antifungal medication (fluconazol). After the surgery, patient developed large epithelial defect. Hyaluronic acid-based artificial tears, perfluorohexyloktan (Evotears ®) and vitamin A ointment were used to improve epithelial healing. Fimosis of eyelid aperture did not allowed application of therapeutic contact lens. We reduced topical antibiotic medication and avoided the use of topical natamycin eye drops for their epithelotoxic effect on a corneal graft. After 4 weeks from surgery, patient has a visual acuity of 2m with correct light perception, corneal graft is adapted and only mild epitethelopathy is present. Plastic surgery referral for eyelid skin autogratfs to correct ectropium and repeated dermatological referral is planned.

Conclusions:

Rapid progression of a corneal infection can be expected in the presence of cicatrical ectropium in connection to ichtyosis. Hyaluronic acid based artificial teras, topical vitamin A ointment and perfluorohexyloktan (Evotears ®) eye drops provided relief and improved healing of large epithelial defect. However, for a good prognosis of a corneal graft, surgical repair of an ectropium is needed.

Financial Disclosure:

None

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