Deep Anterior Lamellar Keratoplasty With Intraoperatively Planned Macroperforation And Full Thickness Donor In A Dense Corneal Scar Due To Perforated Ulcer By Pseudomona In A Patient With Autism, Intellectual Disability And Only Eye

TO PRESENT A DEEP ANTERIOR LAMELLAR KERATOPLASTY WITH INTRAOPERATIVELY PLANNED MACROPERFORATION AND FULL THICKNESS DONOR IN A DENSE CORNEAL SCAR DUE TO ULCER PERFORATED BY PSEUDOMONA IN A PATIENT WITH AUTISM, INTELLECTUAL DISABILITY AND SINGLE EYE.

A PATIENT WITH AUTISM AND INTELLECTUAL DISABILITY PRESENTED BILATERAL PERFORATED ULCER BY PSEUDOMONA. THE LEFT EYE WAS EVISCERATED AND IN THE RIGHT EYE A DEEP ANTERIOR LAMELLAR KERATOPLASTY WITH INTRAOPERATIVELY PLANNED MACROPERFORATION AND FULL THICKNESS DONOR WERE PERFORMED AT CARLOS ANDRADE MARIN HOSPITAL (QUITO ECUADOR)

A 13-YEAR-OLD FEMALE PATIENT WITH AUTISM AND CONGENITAL HEART DISEASE WHO DURING A LONG HOSPITALIZATION IN THE ICU WAS INFECTED BY PSEUDOMONA, SO SHE LOST HER LEFT EYE DUE TO ENDOPHTHALMITIS AND PRESENTED A CORNEAL ULCER WHICH REQUIRED CONJUNCTIVAL COVERING. BEING THIS THE UNIC FUNCTIONAL EYE IT WAS IMPERATIVE AVOID PENETRATING KERATOPLASTY SO A DEEP ANTERIOR LAMELLAR KERATOPLASTY WITH INTRAOPERATIVELY PLANNED MACROPERFORATION AND FULL THICKNESS DONOR WERE PERFORMED THIS WAS DONE .  IN THIS TECHNIQUE A CONTINUE CIRCLE MACROPERFORATION ON THE VISUAL AXIS WHILE KEEPING PATIENT´S DESCEMET BED IN PERIPHERY WERE MADE FOR VISUAL ACUITY RECOVERY.

THE PATIENT IS IN HER SIXTH POSTOPERATIVE MONTH WITH ADEQUATE VISUAL RECOVERY, IMPROVEMENT IN HER AUTONOMY AND RELATIONSHIP WITH THE ENVIRONMENT, THE CORNEA IN THE VISUAL AXIS REMAINS TRANSPARENT AND THE PERIPHERAL FIBROSIS DOES NOT AFFECT THE PATIENT'S DEVELOPMENT

THIS TECHNIQUE PROVEN TO BE A VALID ALTERNATIVE TO VISUALLY RECOVER A PATIENT WITH INTELLECTUAL DISABILITY. THE MANAGEMENT OF A PENETRATING KERATOPLASTY IN THIS POPULATION IS A CHALLENGE DUE TO THE RISK OF EYE RUBING AND LOSS OF SUTURES, SO MAINTAINING THE RECIPIENT DESCEMET LAYER HELPS PROVIDE A SAFER SURGERY