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Oculoplastics

Cornea & External Diseases

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Surgery & Complications
Corneal infiltrate with overlying epithelial defect post penetrating keratoplasty.
Penetrating keratoplasty complicated with infections.

  • Clinical features:
    • Rare complication and may occur early or late postoperatively.
    • Symptoms: reduced vision, hyperemia, ocular pain or chemosis may be misinterpreted as postoperative inflammatory reaction.
    • Signs:
      • May present with conjunctival injection and chemosis
      • Corneal edema
      • Corneal infiltrate or abscess
      • Anterior chamber reaction i.e. cells, flare, fibrin or hypopyon, vitritis
      • May be complicated with retinal involvement
  • Risk factors: organisms from conjunctiva or lids, broken or loose sutures, concomitant anterior vitrectomy, aphakia, previous inflammation or surgery, contaminated donor material (obtained from patients dying from systemic infection / sepsis) or corticosteroid use.
  • Management:
    • Thorough ocular examination (day 1 and 1 week postoperatively) for recognizing objective signs of corneal infiltrate, vitreous clouding and/or hypopyon is crucial.
    • Early recognition of this complication is very important so that immediate treatment should be initiated and devastating visual consequences could be prevented.
    • Broad-spectrum antibiotics such as gentamicin, streptomycin and vancomycin have been routinely added to corneal storage media to help minimizing this postoperative complication.
    • Instillation of topical 5% povidone-iodine solution into the cul-de-sac preoperatively.
    • Should endophthalmitis be suspected, diagnostic and therapeutic measures have to be performed, including cultures and intravitreal antibiotics.

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