RESUMO
BACKGROUND: Corneal perforation is an uncommon complication associated with keratoconus. The first cases of infectious keratitis and corneal perforation associated with corneal hydrops and contact lens wear are reported in two keratoconus patients. METHODS: A retrospective chart review and histopathological examination were carried out. RESULTS: Both patients progressed to corneal perforation and emergency penetrating keratoplasty. One patient cultured Fusarium and the second patient Serratia marcesens. Both patients wore contact lenses against medical advice. CONCLUSIONS: The tear in Descement's membrane, stromal oedema, and epithelial bedewing associated with corneal hydrops results in loss of the epithelial-endothelial barrier of the cornea, creating a conduit for infectious organisms through the cornea. Acute hydrops associated with epithelial keratitis, stromal swelling, and a Descement's membrane tear may be a significant risk factor for infectious keratitis and corneal perforation. Contact lenses should not be worn during an active corneal hydrops owing to the increased risk for severe infectious keratitis and corneal perforation.
Assuntos
Lentes de Contato/efeitos adversos , Doenças da Córnea/etiologia , Infecções Oculares Bacterianas/complicações , Infecções Oculares Fúngicas/complicações , Infecções Oculares/complicações , Ceratite/complicações , Adulto , Antibacterianos , Doenças da Córnea/patologia , Doenças da Córnea/terapia , Quimioterapia Combinada/uso terapêutico , Edema/etiologia , Feminino , Humanos , Ceratite/microbiologia , Ceratocone/complicações , Ceratocone/terapia , Ceratoplastia Penetrante , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura Espontânea/etiologia , Infecções por Serratia/complicações , Resultado do TratamentoRESUMO
A 76-year-old woman hospitalized for treatment of an inferior vena cava thrombus was noted to have eosinophilia as well as asthma, peripheral neuropathy, jaw claudication and visual loss. Pathological review of a temporal artery biopsy revealed vasculitis with eosinophils but no giant cells. Treatment with high dose corticosteroids resulted in improvement of visual acuity from hand motion to 20/60. Whereas at least 6 cases of temporal artery involvement with Churg-Strauss syndrome have been reported, visual loss has occurred in only 3 patients. In each of these cases, visual loss was permanent.