CORNEAL MELTING AFTER EXTRA CAPSULAR EXTRACTION CATARACT SURGERY DUE TO THE UTILISATION OF NSAIDS
Published 2023 - 27th ESCRS Winter Meeting
Reference: P095 | Type: Presented Poster & Poster Submission | DOI: 10.82333/6we4-mk89
Authors: Filali Sadouk Mohamed* 1 , Bennis Ahmed 1 , Chraibi Fouad 1 , Abdellaoui Meryem 1 , Benatiya Andaloussi Idriss 1
1Ophtalmology,CHU HASSAN II Fes,FES,Morocco
Purpose
Corneal melt, an ophthalmological condition in which corneal epithelium is lost accompanied by thinning of the corneal stroma, can lead to corneal perforation and cause loss of vision.
Corneal melt is the most serious side effect of topical nonsteroidal anti-inflammatory drugs (NSAIDs), one of the topical treatments of ocular inflammation.
NSAID-induced corneal melt (NICM), initially doubted, is real, having been reported by multiple groups. NICM is induced by all but one of the approved ocular NSAIDs and occurs usually in patients whose cornea is compromised by ocular surgery, diabetes, or autoimmune diseases.
Setting
Methods
Results
The patient had a history of cataract surgery by extra-caspular extraction dating back 4 weeks, a poorly balanced type II diabetes, in addition we found no local or systemic signs in favor of a systemic disease.
The initial examination found in the right eye: visual acuity limited to seeing the hand move, conjunctival hyperemia, a peri keratic circle, clean and tight corneal points, presence of an axial corneal perforation measuring 2mm by 1.5mm with peri lesion oedema, a reduced anterior chamber with a herniation of the iris through the perforation, patient was pseudophakic with an implant in place.
Patient was admitted to the operating room, under general anesthesia, the perforation was closed with a tenon patch after release and reintroduction of the iris and an air bubble was injected into the anterior chamber.
Follow-up was favorable with reintegration of the tenon patch into the corneal stroma with scar formation and recovery of visual acuity at 1/10°.
Conclusion
Awareness of this ominous side effect, its risk factors, and the need for prompt action once diagnosed, including NSAID discontinuation, will help mitigate the risk of NICM. Further understanding of NICM and development of efficacious treatments or safer alternatives should help eliminate this rare, but severe, side effect of ocular NSAIDs. The tenon patch remains an alternative that is always available for rapid management of perforations and for restoring the integrity of the eyeball in the absence of other means