Bilateral Corneal Trophic Ulcers and Subsequent Infectious Keratitis in a Patient with...
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Transcript of Bilateral Corneal Trophic Ulcers and Subsequent Infectious Keratitis in a Patient with...
Bilateral Corneal Trophic Ulcers and Subsequent Infectious Keratitis in a
Patient with Graft-versus-host Disease
Yonca Aydın Akova, MD
Bayındır Hospital,Ankara, Turkey
Financial interest Alcon, Allergan, Bausch& Lomb, Thea, Deva
Purpose
• To report the clinical picture, complications and therapeutic approach in a patient with chronic graft versus host disease (GVHD)
Case Presentation• 54-year-old men with
chronic myeloid leukemia• Bone marrow
transplantation • He developed chronic GVHD
– Severe dry eye, Schirmer test without anesthesia 1 mm, OU
– Bilateral trophic corneal ulcers involving the whole cornea
– Crystalline keratopathy in the right eye
Therapy
• Topical therapy– Autologous serum
50 %– Unpreserved topical
steroids 3x1 – Topical cyclosporine
A, 0.05% 4x1– Unpreserved
artificial tears 8x1
• Therapeutic soft contact lenses
• Silicone punctum plugs
• Systemic therapy– Doxycyline– Prednisolone– Immunosuppressive
therapy (mycofenolate and cyclosporine )
– Photopheresis
Clinical Findings• Bacterial ulcer with
hypopyon in the left eye
• Conjunctival and corneal cultures negative
• Response to topical fortified vancomycine and ceftazidime therapy
Bacterial keratitis with hypopyon
Clinical Findings
One months later • Multiple corneal
infiltrates, OD• Cultures were positive
for candida albicans • Response to topical
amphotericin B and topical voriconazole 1% therapy Candida keratitis with multiple infiltrates
Clinical Findings
• Infectious crystalline keratopathy and satellite infiltrates caused by candida albicans in the right eye
Satellite infiltrates
After Treatment
Clinical Findings
• Response to topical amphotericin B and topical voriconazole 1% therapy
After Treatment
Conclusions• Patients with chronic GVHD may develop
severe inflammatory changes in the ocular surface– Severe dry eye –Persistent trophic ulcers – Infectious keratitis • Bacterial keratitis• Fungal keratitis
Conclusions
• Crystalline keratopathy may develop due to corneal infections
• Microbial causes include not only bacteria but fungi as well
• GVHD patients should be carefully evaluated for such severe complications in order to start the appropriate treatment timely