Corneal Healing After Penetrating Trauma-8 Months Follow-Up

Eye trauma is an important cause of vision impairment and blindness. It is estimated that almost 60 million cases of ocular trauma occurred worldwide in 2019¹, with corneal injuries accounting for 6.6% of eye injuries². Cornea is a unique tissue for studying wound healing due to its transparency and accessibility for monitoring and imaging. Purpose of this case is to evaluate corneal changes observed during the healing process following a penetrating corneal injury utilizing Pentacam® corneal tomography, anterior segment optical coherence tomography HRA + OCT Spectralis® and Nidek® specular microscopy.

University Eye Clinic, University Hospital “Sveti Duh”, Sveti Duh 64, Zagreb, Croatia; Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

A 45-year-old male presented to the emergency department with a right eye injury caused by an unknown object. At referral, best corrected visual acuity on Snellen chart was 0,3 in the right eye and 1.0 in the left eye. Biomicroscopy revealed two parallel linear paracentral corneal lacerations, one of which was full thickness, confirmed with anterior segment OCT. An iris defect corresponding to the site of corneal injury was observed, while the lens appeared intact. Fundus examination was limited. A CT scan excluded the presence of an intraocular foreign body. Penetrating corneal injury without intraocular foreign body was diagnosed. A single cruciate 10–0 nylon suture placed to close corneal laceration was removed 6 months postoperatively.

Serial evaluation of corneal tomography, specular microscopy and AS-OCT demonstrated progressive corneal remodeling following penetrating corneal injury. Prior to suture removal,keratometric values remained relatively stable with mild fluctuations, while minimal corneal thickness increased, suggesting ongoing stromal healing.Q-value showed gradual normalization from a more prolate configuration (−0.40 at 7 weeks) toward the more physiological range (−0.13 at 8 months).After suture removal,there was a mild reduction in keratometric values and a Q-value.Pachymetric parameters showed slight thinning.Endothelial cell density remained relatively preserved throughout follow-up, despite fluctuations in cell morphology and coefficient of variation.

Corneal tomography and specular microscopy demonstrated dynamic but overall stable structural changes during the healing process following penetrating corneal injury with final outcome depending on the severity of injury, surgical technique and postoperative management. Overall, corneal tomography and specular microscopy proved to be valuable, complementary tools for monitoring corneal changes during post-traumatic healing process.