CORNEAL PERFORATION AFTER RADIOTHERAPY : A CASE REPORT

Published 2024 - 28th ESCRS Winter Meeting

Reference: P156 | Type: Presented Poster & Poster | DOI: 10.82333/mjmv-2c58

Authors: Naoual Mtalai* ¹ , Sara Ennaki ¹ , Reda Benchekroun ¹ , Ghizlane Daghouj ¹ , Zyad Laftimi ¹ , Loubna Elmaaloum ¹ , Bouchra Allali ¹ , Asmaa Elkettani ¹

¹PEDIATRIC OPHTALMOLOGY,20 AUGUST HOSPITAL,CASABLANCA,Morocco

Purpose

To report a rare corneal complication after high-dose external radiotherapy given to patients for gland carcinomas. The impact of prophylactic measures to improve long-term ocular surface health is also assessed.

Setting

Ocular complications of radiotherapy are multiple due to their heterogeneity.They can affect all ocular structures : conjunctival irritation, dry eyes, corneal necrosis, cataracts, retinal damage and optic neuropathy. The incidence of post-radiation corneal necrosis is very low.

Methods

A case report : we present a rare case of corneal perforation in a patient treated with radiotherapy for a poorly differentiated carcinoma of the

cavum: Naso-Pharyngeal Carcinoma (NPC)

Results

We report the case of a 63-year-old woman, followed at the oncology and radiotherapy department, of the Ibn Rochd university hospital, for a poorly differentiated Naso-Pharyngeal Carcinoma NPC with endo-cranial and pulmonary metastasis.

Past history: Onco-Radiotherapy: received 11 months prior to the ophthalmologic consultation: 6 courses of chemotherapy: Gemzar - Carboplatin Radiotherapy (70 Gy) (35 fractions with conventional fractionation of 2 Gy/session).

Functional signs : Repeated episodes of ocular redness in the right eye concomitant with radiotherapy sessions. No notion of ocular trauma.

Worsening of symptoms with onset of ocular pain and redness associated with reduced visual acuity in the right eye.

Visual acuity of the right eye was a positive perception of light. Purulent secretions were present. Corneal ulcer with diffuse superficial punctate keratitis and fibrin in the anterior chamber. Ocular ultrasound: transsolar vitreous - flat retina. The left eye was normal.

Prescribed treatment : Empirical local TBA (Norfloxacin) + artificial tears (drop/hour) + lubricating ointment. Protection of affected eye during radiotherapy sessions. Regular check-ups (1x/week). There was a persistence of corneal ulceration with partial regression of fibrin.

1 month after the first consultation, the ulcer was complicated with a corneal perforation that needed a conjunctival flap to cover the defect.

NB: the patient died 15 days after the surgery from a very poor general condition

Conclusion

Radiotherapy continues to play an important role in the management of head and neck tumours.

Ocular complications are variable. There are a few published cases of serious complications such as corneal perforation.

It is therefore essential to prevent these complications as far as possible, and to implement preventive measures during radiotherapy sessions.