Efficiency Of Amniotic Membrane Transplantation In Spontaneous Corneal Melting Following Catarac Surgery

Progressive sterile keratolysis can be seen after cataract surgery. Corneal melting is a rare but potentially blinding condition that manifests as rapid and significant thinning of the corneal stroma, culminating in a maximum perforation.
Several factors have theoretically been incriminated in this pathology: in particular dry eye, systemic pathologies but especially the use of NSAIDs.
We report here the case of management of a spontaneous perforation in post-cataract surgery with simple initial operative follow-up

Department of ophthalmology, Mohammed VI university hospital, Oujda , Morocco 

70-year-old patient , with no medical history , operated for cataract by phacoemulsification 15 days before admission with simple postoperative course. she presented with Painful red right eye with decreased visual acuity, tearing and  blephrospasm, At the initial examination in the Right Eye: counting fingers, hyperemia Perforated paracentral ulcer, athalamia . Contralateral eye examination was normal. She has no systemic signs , nor ocular surface disease. we concluded to a post-catarct surgery spontaneous melting. Due to the similiaries with viral ulcers, we prefered to use antiviral IV therapy , with placement of a theraoerutic lens.  An amniotic membrane transplantation was performed : multiple layers to close the perforation , inlay to favorise the epithelial growth and finally overlay to induce a cicatrisation of the periphery of ulceration ( figure 1). After 6 weeks of follow-up, a spectacular improvement was obtained , with a brut visual acuity a 0.2, and a total closure of perforation in anetrior segment OCT. 

1. Acute sterile corneal melting after cataract surgery is defined as: 1)  occurrence within 1 month after cataract surgery, 2) absence of any signs of infection, and 3) around paracentral cornea. This condition has been shown to be linked to a variety of factors including dry eye, topical medications (NSAIDs++) and autoimmune diseases 
2. Histopathological examination of corneal button revealed an elevated level of matrix metalloproteinase (MMP)-8 in case of spontaneous perforation on use of NSAIDs .
3. Due to the few cases in litterature , there is no consensus for treatement. We didn't found described cases of use of amnitoic membrane in this case, which make our case intresting , as it adds a new choice to treat this rare but blinding situation.