PREPERFORATIVE NEUROTROPHIC ULCER: NEW MANAGEMENT APPROACH

Published 2022 - 26th ESCRS Winter Meeting

Reference: P133 | Type: Abstracts | DOI: 10.82333/03yh-6t02

Authors: Zakaria Cheikh* ¹ , soukaina Homaide ² , sophia boussetta ³ , Adil Mchachi ⁴ , leila Benhmidoune ⁵ , Abderrahim Chakib ⁵ , rachid Rayad ⁶ , Mohamed El Belhadji ⁵

¹ophtalmologie adultes,Chu Ibn rochd hopital 20 Aout,casablanca,Morocco, ²Ophtalmogie adultes, chu ibn rochdHopital 20 aout 1953,casablanca,Morocco, ³ophtalmologie Adultes,chu ibn rochd,casablanca,Morocco, ⁴ophtalmogie adultes,Chu ibn Rochd hopital 20 aout 1953,casablanca,Morocco, ⁵Ophtalmologie Adultes,Chu Ibn Rochd Hopital 20 Aout 1953,casablanca,Morocco, ⁶ophtalmologie Adultes,Chu Ibn Rochd Hopital 20 Aout 1953,casablanca,Morocco

Purpose

Neurotrophic keratitis is a chronic degenerative disease of the corneal epithelium secondary to a reduction or absence of corneal sensitivity. The most common etiology is the herpes simplex virus. It poses a double problem, firstly diagnostic; because the corneal sensitivity examination is often omitted, and secondly therapeutic, because to the absence of a standardized consensus and the difficulty of management. The aim of this case is to evaluate the effectiveness of autologous serum associated with scleral lens.

Setting

We report a case of a 32-year-old man, followed for neurotrophic keratopathy of herpetic origin at the stage of preperforative ulcer, since 20 days, resistant to treatment by intensive lubrication. The restoration of corneal integrity was an absolute emergency. On examination, the right eye showed visual acuity at 3 meters, the anterior segment showed a nasal para-central ulcer with raised edges, oval shape, the lower half of the cornea surrounded by edema and absent corneal sensitivity, a good anterior chamber, a clear lens with an unremarkable fundus. The left eye had an uncorrected visual acuity of 10/10 and an unremarkable examination.

Methods

The initial management was the placement of synthetic glue at the bottom of the ulcer, 2 days later we had a rejection of the glue; and then we opted for adapted scleral lenses for therapeutic purposes with placement of autologous serum as a filling solution for the scleral lens. After 3 months, the evolution was marked by re-epithelization with partial recovery of corneal sensitivity.

Results

In all chronic corneal ulcers, corneal sensitivity should be tested. Current medical or surgical treatments for neurotrophic ulcers are aimed at improving epithelial healing, slowing down the evolution and preventing possible complications. The use of scleral, high Dk, non-windowed, autologous serum-filled lenses in daily use allows the restoration of corneal integrity and sensitivity.

Conclusion

The diagnosis and management of neurotrophic keratitis is a real challenge. The use of the scleral lens as a reservoir for the active ingredient (autologous serum in our case) can give a new impetus to the management of this corneal pathology.