ESCRS - CR25 - SERIOUS CORNEAL MELTING AND CALCIFIC BAND KERATOPATHY ASSOCIATED WITH ABUSE OF NONSTEROIDAL ANTI-INFLAMMATORY AND PHOSPHATE-CONTAINING EYE DROPS AFTER CATARACT SURGERY

SERIOUS CORNEAL MELTING AND CALCIFIC BAND KERATOPATHY ASSOCIATED WITH ABUSE OF NONSTEROIDAL ANTI-INFLAMMATORY AND PHOSPHATE-CONTAINING EYE DROPS AFTER CATARACT SURGERY

Published 2023 - 27th ESCRS Winter Meeting

Reference: CR25 | Type: Case Report (Cornea Day) | DOI: 10.82333/0h73-px07

Authors: Ana Margarida Ferreira* 1 , Ana Maria Cunha 2 , Teresa Dinah Bragança 1 , Pedro Neves Cardoso 1 , Luís Torrão 1 , Raúl Moreira 1 , Fernando Falcão Reis 2 , João Pinheiro Costa 2

1Ophthalmology Department,Centro Hospitalar Universitário São João,Porto,Portugal, 2Ophthalmology Department,Centro Hospitalar Universitário São João,Porto,Portugal;Surgery and Physiology Department,Faculdade de Medicina Universidade do Porto,Porto,Portugal

Purpose

Topical nonsteroidal anti-inflammatory drugs (NSAID) are helpful anti-inflammatory agents that are used to treat many ocular inflammatory conditions, including postoperative status. In susceptible patients, frequent and continued use of topical NSAID, may result in corneal epithelial breakdown and corneal melting. Our purpose is to describe a patient with a serious corneal melting and corneal calcific band keratopathy associated with the abuse of topical NSAIDs and phosphate-containing eye drops after an uneventful cataract surgery.  

Setting

Clinical and imaging description of a clinical case.

Report of case

We described an 81-year-old woman with a serious corneal melting and corneal calcific band keratopathy in the right eye due to use of NSAID drops (Yellox®) and dexamethasone with phosphate-based excipient (Dexaval®). Patient was referred to our corneal department 3 weeks after an uneventful cataract surgery. Initially, the visual acuity was 1/10 in the right eye and 8/10 on the left eye. The anterior segment examination of the right eye revealed complete epithelium loss and corneal melting in the inferior half with calcium-phosphate deposition obscuring visual axis. After the suspension of Yellox® and Dexaval® and starting treatment with a therapeutic contact lens, abundant artificial tears eye drops, topical antibiotic and corticosteroid preservative free, a complete corneal re-epithelization was identified, despite the persistence of a dense calcific keratopathy. Six months later, the visual acuity decreased to less than 0.05 and the calcific keratopathy increased with visual axis involvement. Visual rehabilitation was started with an uneventful Deep Anterior Lamellar Keratoplasty (DALK) surgery.

Conclusion / Take home message

This case report heightens the importance of being aware of such complications and the relevance of optimizing prescriptions always maintaining ocular surface integrity and avoiding iatrogenic harm to patients.