Superimposed fungal ulcer after fibrin glue sealant in infectious corneal ulcer

Abstract

A healthy 27-year-old woman with a corneal ulcer underwent fibrin gluing with a bandage contact lens twice, due to an impending perforation. The ulcer lesion slowly progressed, unresponsive to topical antibiotics and amphotericin B. We removed the gluing patch and performed a corneal or scraping or biopsy with multiple amniotic membrane grafts to seal the thinned or perforated cornea. Three days after the surgery, the corneal cultures grew Fusarium, as well as Enterococcus faecalis. Three weeks after surgery, the outermost layer of amniotic membranes, serving as a temporary patch, was removed. The anterior chamber was clear without cells. The signs of infection clinically and symptomatically cleared up four weeks later. Two months after surgery, the lesion became enhanced by amniotic membranes. The use of fibrin glue in infectious keratitis should be avoided, because it not only masks the underlying lesion, but it also interferes with drug penetration into the underlying lesion.

Keywords: Corneal perforation; Corneal ulcer; Fibrin glue; Tissue adhesives; Tissue glue.

Fig. 1

(A) Large ulcer, measuring 5×3 mm, with overlying fibrin glue, which was aggravated and unresponsive to topical broad-spectrum antibiotics and amphotericin B after one week. (B) Immediately after removal of the bandage contact lens and fibrin glue, a deep necrotic lesion under the obscure glue was observed, and micro-leaking and an iridocorneal adhesion was found at the center of thinned ulcer base.

Fig. 2

(A) Three weeks after surgery, the multilayered amniotic membrane was well attached and symptomatical and clinical improvements were observed. (B) Two months after surgery, the outermost layer of the amniotic membranes, serving as a temporary patch, was removed and the lesion became totally opaque and sclerotic. The thinned area was well enhanced by permanent multiple amniotic grafts.