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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 33-35

Acute corneal perforation in advanced keratoglobus


Department of Cornea, Rajan Eye Care Hospital Pvt Ltd, Chennai, Tamil Nadu, India

Date of Submission21-Apr-2021
Date of Acceptance19-Jul-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Sujatha Mohan
#5, Vidyodya 2nd Street, T. Nagar, Chennai - 600 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_752_21

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  Abstract 


Keratoglobus is a noninflammatory ectatic disorder characterized by thinning from limbus to limbus resulting in globular protrusion of the cornea. This is a case report of acute corneal perforation in a 15-year-old female came to our outpatient department. She had also been diagnosed as keratoglobus in the right eye. Now, she has been presented with acute corneal perforation with micro leak in the right eye. She has been treated with cyanoacrylate glue followed by bandage contact lens. On the next day, penetrating keratoplasty was done. Her postoperative vision improved to 6/60.

Keywords: Acute corneal perforation with micro leak, cyanoacrylate glue with bandage contact lens, keratoglobus, penetrating keratoplasty


How to cite this article:
Mohan S, Sujitha D. Acute corneal perforation in advanced keratoglobus. Indian J Ophthalmol Case Rep 2022;2:33-5

How to cite this URL:
Mohan S, Sujitha D. Acute corneal perforation in advanced keratoglobus. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Jan 19];2:33-5. Available from: https://www.ijoreports.in/text.asp?2022/2/1/33/334975



Keratoglobus is a noninflammatory ectatic disorder of the cornea characterized by thinning from limbus to limbus resulting from globular protrusion of the cornea.[1] Acquired keratoglobus has been described in association with chronic marginal blepharitis, vernal keratoconjuctivitis, dysthyroid ophthalmopathy, Marfan syndrome, and Ehlers-Danlos syndrome.[2] Congenital keratoglobus has been described with Leber's amaurosis and blue sclera syndrome.[3]


  Case Report Top


A 15-year-old female presented to our outpatient department with complaints of pain, watering, photophobia, and decreased vision in the right eye of 1 day duration. She also had history of allergic disorder and eye rubbing. Keratoglobus was diagnosed elsewhere and the left eye penetrating keratoplasty was done in 2013. She sustained injury to the left eye for which lensectomy with anterior vitrectomy and graft repair was done in 2015, which resulted in failed graft left eye. Pachymetry done in 2017 in the right eye showed central corneal thickness of 203 μm. She was advised to undergo penetrating keratoplasty, but the patient deferred. Now, she has been presented with acute corneal perforation with micro leak in the right eye.

Examination

Her best-corrected visual acuity in the right eye was Counting fingers (CF) at 3 m and the left eye was perception of light.

The patient had severe photophobia on examination. Slit-lamp examination revealed blue sclera, an irregular surface and thin cornea. Fluorescein stain revealed an acute corneal perforation with micro leak in the right eye [Figure 1]. Anterior chamber was formed. There was a totally detached Descemet membrane floating in the mid chamber [Figure 2]. Finger tension revealed soft eye. Anterior segment optical coherence tomography (ASOCT) showed evidence of fluid pockets in the stroma [Figure 3]. Descemet membrane (DM) scroll was not visualized on ASOCT. Topography and pentacam [Figure 4]a and [Figure 4]b taken 7 years before revealed Keratoglobus. Gentle B-Scan revealed a normal posterior segment.
Figure 1: Flourescein stain showing micro leakNow

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Figure 2: Arrow showing rolled DMD

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Figure 3: ASOCT showing fluid pockets in the thinned out stroma

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Figure 4: (a) topography. (b) Pentacam revealing keratoglobus

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Management

Under topical anesthesia, she was treated with cyanoacrylate glue to seal the micro perforation followed by fitting of bandage contact lens [Figure 5].
Figure 5: Cyanoacrylate glue with bandage contact lens

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Penetrating keratoplasty was done on the next day under general anesthesia. The graft donor size was 11.5 and recipient size 11 mm, respectively, to encompass the ectatic cornea. Graft was sutured with 16 interrupted 10-0 nylon sutures. Large graft was done to encompass the cone and remove all the ectatic cornea. Her first day postoperative vision improved to 6/60 [Figure 6].
Figure 6: Clear graft taken on the first postoperative day

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  Discussion Top


Keratoglobus is primarily considered a congenital disorder present since birth.[4] The congenital form is always bilateral[1]; our case also showed bilateral involvement. Corneal tear or globe rupture in keratoglobus can occur spontaneously or following trauma. Managing keratoglobus is a challenging procedure.

Conservative management in the form of spectacles and contact lens is described though trivial trauma such as contact lens insertion and removal can cause rupture of the globe.[5]

Tuck in lamellar keratoplasty that included a central lamellar keratoplasty with intrastromal tucking of the peripheral flange can be performed.[6]

Penetrating keratoplasty will be the challenging procedure in children due to low scleral rigidity and increased vitreous positive pressure.[7] However, wellcontrolled general anesthesia, low intraocular pressure, and intravenous mannitol procedures can be carried out. Rapid wound healing causes early suture loosening which mandates suture replacements or removal. Hence, 10-0 nylon interrupted sutures are to be performed.


  Conclusion Top


This case is reported for its timely intervention and outcome after proceeding with the challenging procedure. This case is presented to highlight the need for close follow-up and early intervention in keratoglobus to prevent sight-threatening complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wallang BS, Das S. Keratoglobus. Eye (Lond) 2013;27:1004-12.  Back to cited text no. 1
    
2.
Cameron JA. Keratoglobus. Cornea 1993;12:124-30.  Back to cited text no. 2
    
3.
Cameron JA, Cotter JB, Risco JM, Alvarez H. Epikeratoplasty for keratoglobus associated with blue sclera. Ophthalmology 1991;98:446-52.  Back to cited text no. 3
    
4.
Gregoratos ND, Bartsocas CS, Papas K. Blue sclera with keratoglobus and brittle cornea. Br J Ophthalmol 1971;55:424-6.  Back to cited text no. 4
    
5.
Mahadevan R, Fathima A, Rajan R, Arumugam AO. An ocular surface prosthesis for keratoglobus and Terrien's marginal degeneration. Optom Vis Sci 2014;91 (4 Suppl 1):s34-9.  Back to cited text no. 5
    
6.
Kaushal S, Jhanji V, Sharma N, Tandon R, Titiyal JS, Vajpayee RB. Tuck in lamellar keratoplasty (TILK) for corneal ectasias involving corneal periphery. Br J Opthalmol 2008;92:286-90.  Back to cited text no. 6
    
7.
Gloov P. Paediatric penetrating keratoplasty. In: Krachmer JH, Mannis M, Holland FJ, editors. Cornea. Vol. 3. St Louis MO, Mosby; 1997. p. (73)-56.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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