Misleading Ulcers: Post-Pk Infections Mimicking Neurotrophic Keratopathy

Published 2025 - 43rd Congress of the ESCRS

Reference: PO139 | Type: Case Report | DOI: 10.82333/xh62-s282

Authors: Hasmik Gasparyan* ¹ , Lusine Kambulyan ² , Zarine Sargsyan ² , Roza Ohanyan ² , Anna Hovakimyan ³

¹Ophthalmology,Yerevan State Medical University,Yerevan,Armenia;Cornea-Uveitis,Ophthalmological center after S.V. Malayan,Yerevan,Armenia, ²Cornea-Uveitis,Ophthalmological center after S.V. Malayan,Yerevan,Armenia, ³Cornea-Uveitis,Ophthalmological center after S.V. Malayan,Yerevan,Armenia;Ophthalmology,Yerevan State Medical University,Yerevan,Armenia

Purpose

This case report highlights the diagnostic challenge of post-penetrating keratoplasty (PK) infections that closely mimic neurotrophic ulcers. We present two cases where early diagnosis and appropriate treatment played a crucial role in preserving corneal graft integrity and vision.

Setting

The cases were managed at S.V. Malayan Eye Center, Department of Cornea-Uveitis, Yerevan, Armenia.

Report of case

Case 1: A 50-year-old male, who underwent PK for keratoconus 37 years ago, presented with a persistent, non-healing corneal ulcer. The ulcer exhibited characteristic features of a neurotrophic ulcer, yet microbiological analysis confirmed Staphylococcus warneri infection, while PCR tests for viruses were negative. After 8 weeks of medical therapy, the ulcer healed. However, two months later, the patient suffered a blunt ocular trauma (bottle cork), resulting in corneal perforation. He underwent amniotic membrane transplantation, which led to sealing in 10 days. Six months later the patient underwent graft replacement (PK) for visual rehabilitation. The visual acuity improved to 20/40.

Case 2: A 50-year-old male with a history of PK performed for the treatment of bullous keratopathy 16 years ago, developed a chronic, non-healing graft ulcer mimicking a neurotrophic ulcer. Culture identified Staphylococcus haemolyticus, while PCR tests for viruses were negative. The ulcer responded to medical treatment in 10 weeks. Six months later the patient regained 20/200 visual acuity.

Conclusion/Take home message

Post-PK infections can mimic neurotrophic ulcers, posing a significant diagnostic challenge. The ulcers in both cases demonstrated neurotrophic-like picture with oval-shaped ulcer with swollen epithelial edges and underlying stromal edema. Microbial culture and sensitivity testing are essential for distinguishing infectious from non-infectious ulcers, ensuring timely intervention. Early recognition, targeted treatment, and long-term follow-up are crucial for maintaining graft clarity and even improvement of vision.