Dmek In Endothelial Decompensation After Accidental Exposure To Chlorhexidine
Published 2023 - 41st Congress of the ESCRS
Reference: PO0674 | Type: Free paper | DOI: 10.82333/wm0g-yv76
Authors: Francisco Manuel Hermoso Fernandez* 1 , Antonio Romero Titos 1 , Jesús Daniel Martínez Rodríguez 2 , Beatriz García Checa 1 , Jose Vilchez González 1 , Rocío Mora Romero 1 , Blanca Revelles Peñas 1
1Ophthalmology,Hospital Universitario Clínico San Cecilio,Granada,Spain, 2Ophthalmology,Instituto Oftalmológico de Granada ,Granada,Spain
Purpose
To describe the management of endothelial decompensation after accidental exposure to Chlorhexidine. Factors that have to be taken into consideration.
Setting
Department of Ophthalmology of the San Cecilio University Hospital of Granada, Spain. Department of Ophthalmology, Instituto Oftalmológico de Granada , Granada, Spain
Methods
Observational case report. The description of a 48-year-old man with an endothelial decompensation after accidental exposure to Chlorhexidine. We portray the findings and the management. We also used the PubMed database to find other prospective or retrospective studies.
Results
We present a case of a 48-year-old man, phakic who underwent lower eyelid blepharoplasty two weeks earlier, he presented loss of visual acuity (VA) in his right eye (RE), pain, and photophobia. The anamnesis confirmed the use of 0.5% Chlorhexidine for periocular infectious prophylaxis prior to blepharoplasty. The VA in RE was 0.2. The slit lamp revealed full-thickness corneal edema, Descemet's striae, and epithelial microbulles in the central 7 mm. Medical treatment was prescribed: Dexamethasone eye drops 1 mg/ml every 8/h and 5% sodium chloride eye drops every 6/h. Due to lack of response to medical treatment, DMEK was performed, which was carried out with an 8mm of diameter. The postoperative period was uneventful with a VA in RE of 1.0.
Conclusions
- Chlorhexidine is an antiseptic with bactericidal action commonly used as infectious prophylaxis. However, despite its antiseptic effectiveness, its toxicity can cause direct damage to the cornea through a dose-dependent mechanism that would include: de-epithelialization, loss of endothelial cells with associated stromal edema and finally bullous keratopathy.
- Chlorhexidine is an effective antiseptic that can cause corneal toxicity despite the use of corneal shields.
- DMEK could be a first-line treatment in those cases of endothelial decompensation associated with the use of Chlorhexidine prior to the appearance of irreversible cicatricial changes in Stroma and Descemet.