Corneal Ulceration As A Result Of Malnutrition And Vitamin A Deficiency In A Patient With Severe Weight Loss After Bariatric Surgery And Cholecystectomy.

Published 2022 - 40th Congress of the ESCRS

Reference: PP23.06 | Type: ESCRS 2022 - Posters | DOI: 10.82333/bbhv-gt37

Authors: Raquel Belillas-Núñez* ¹ , Laura Modamio-Gardeta ¹ , Hugo Santiago-Balsera ¹ , Carmen Fátima Rodriguez-Hernández ¹ , Javier Orduña-Azcona ¹ , Beatriz Galán-García ¹ , Germán Ancochea-Díaz ¹ , Daniel Munck-Sánchez ²

¹Department of Ophthalmology,Hospital Universitario Infanta Cristina,Madrid,Spain, ²Department of Ophthalmology,Hospital Universitario 12 de Octubre,Madrid,Spain

Purpose

To present the clinical evolution, surgical and medical management of a patient with corneal ulceration associated with severe malnutrition and hypovitaminosis A after bariatric surgery and cholecystectomy and to show its clinical features and evolution revealed by anterior segment optical coherence tomography (AS-OCT) and anterior segment images.

Setting

Hospital Universitario Infanta Cristina. Department of Ophthalmology. Parla (Madrid), Spain.

Methods

A 53-year-old male reported ocular pain in the right eye (OD) for the last week. He had a previous history of bariatric surgery and cholecystectomy, followed by a restrictive diet and severe weight loss.

He presented a paracentral corneal ulcer with severe thinning (stromal thickness 300 microns) and endothelial folds. The corneal defect was registered by AS-OCT and retinographies. Blood test revealed a deficit of vitamin A and E.

Treatment with topical erythromycin, plasma rich in growth factors eye drops, artificial tears, oral doxycycline and a multivitamin complex was initiated. Days after, a multilayer amniotic membrane transplantation was performed and repeated after 5 weeks due to persistent corneal thinning.

Results

After the second surgical procedure, a significant improvement was observed, with an increase in corneal thickness up to 500 and a best corrected visual acuity of 20/32 in OD. Treatment with artificial tear drops and oral intake of multivitamin complexes was maintained.

The patient expired six months after the initial diagnosis due to systemic complications and sudden liver failure so vitamin A levels could not be tested after treatment.

Conclusions

Vitamin A deficiency is a rare condition in developed countries in absence of abnormalities in its digestion, absorption, transportation or storage but must be suspected in chronically ill or cachectic patients with corneal ulcerations.

Vitamin A deficiency is thought to induce alterations in corneal metabolism which could make the cornea more susceptible to stromal necrosis even in the absence of an epithelial defect.

It is therefore important to suspect and perform blood tests to detect this condition and treat it accordingly, especially in presence of severe malnutrition/malabsorption syndromes or in the event of ulcers unresponsive to treatment that may lead to corneal thinning and even perforation.