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Ectasia following infectious keratitis: case report

Poster Details

First Author: R.Almeida PORTUGAL

Co Author(s):    F. Rodrigues   M. Santos   R. Siqueira   P. Contarini   J. Salgado-Borges   R. Ambrósio Jr

Abstract Details



Purpose:

To describe a case of secondary ectasia due to extreme corneal thinning after infectious keratitis in a cosmetic contact lens user, who had successful treatment with rigid contact lens fitting despite moderate corneal opacity.

Setting:

Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brasil.

Methods:

Case report.

Results:

A 22 year old male, cosmetic contact lens user, first presented with severe keratitis in his right eye (OD). Significant worsening was reported 24 hours after empiric antibiotic therapy, with ciliary injection, stromal infiltration and hypopion. Microbiologic work up revealed Pseudomonas aeruginosa. There was only modest clinical improvement despite intensive topical treatment with fortified antibiotics. Empiric treatment for acanthamoeba was initiated with no resolution of keratitis. After 4 negative corneal scrapings, antifungal therapy was initiated with a good clinical response. After healing infectious focus, local steroids and immunosuppressive agents were used to minimize stromal haze. One year later, the eye was quiet with moderate corneal opacity. Total corneal thickness was 228 μm in OD, while 561 μm in OS. Significant protrusion and irregular curvature were observed by corneal tomography. Due to the severe thinning, no therapeutic corneal ablation was considered. Before keratoplasty, patient was referred for contact lens fitting trial. Rigid gas permeable fitting enabled visual acuity of 20/25 in OD.

Conclusions:

Significant stromal loss and thinning may lead to secondary ectasia. Good visual outcome is possible with RGP contact lenses despite of corneal opacity. The risk for infectious keratitis among contact lenses users should be considered. FINANCIAL INTEREST: NONE

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