RESUMEN
A 34year-old man presented with diminution of vision, pain and whitish opacity in both eyes (right eye followed by left eye) since 1 week. He is a known case of chronic alcoholic abuse. He had multiple episodes of haemoptysis in the past. On general physical examination, he was severely malnourished with multiple oral ulcers. Visual acuity at presentation was light perception in both eyes with projection of rays accurate in all quadrants. Slit-lamp biomicroscopy revealed bilateral total corneal melt with diffuse conjunctival congestion. Corneal scrapings and blood investigations were done and he was started on empirical topical and systemic therapy followed by surgical intervention, with large corneal grafts in both the eyes (right eye followed by left eye) with 1 day interval. The visual gain in both the eyes were 20/400 at first postoperative day. The right eye developed severe fibrinous reaction on the second postoperative day which resolved with topical antibiotics, topical steroids and systemic steroids. The patient was followed up via telemedicine (due to COVID-19 outbreak) and he is able to carry out his daily routine work independently.
Asunto(s)
Alcoholismo/complicaciones , Úlcera de la Córnea/etiología , Desnutrición Proteico-Calórica/complicaciones , Deficiencia de Vitamina A/complicaciones , Adulto , Antibacterianos/uso terapéutico , Avitaminosis/diagnóstico , Avitaminosis/tratamiento farmacológico , Trasplante de Córnea , Úlcera de la Córnea/patología , Úlcera de la Córnea/terapia , Intervención Médica Temprana , Humanos , Masculino , Necrosis , Microscopía con Lámpara de Hendidura , Vitamina A/uso terapéutico , Deficiencia de Vitamina A/diagnóstico , Deficiencia de Vitamina A/tratamiento farmacológico , Vitaminas/uso terapéuticoRESUMEN
To describe a smartphone-based telemedicine tool for monitoring of corneal ulcer size during the corona pandemic, a simple "U"-shaped tool was constructed using three Schirmer's strips that were provided to the patients with small to medium-sized corneal ulcers. The patient and the attendant were trained to use this simple U-shaped tool at home and send digital images to the treating ophthalmologist, to monitor the course of the ulcer. The tool was used in five eyes of five patients with active microbial keratitis. Patients were followed up regularly with the use of telemedicine facility every 48 h for an average duration of 7.6 days (range 6-9 days). In all the five eyes, assessment of the serial images with U-shaped tool showed decrease in size of corneal ulcer, which corroborated with subjective improvement in symptoms. Hence, the novel "'U'-shaped tool" may provide an effective measure in following-up of corneal ulcer patients in times of the COVID-19 pandemic, obviating frequent hospital visits and risk of contracting COVID.