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Case Reports
. 2016 Jan-Mar;11(1):108-11.
doi: 10.4103/2008-322X.180705.

Recurrent Corneal Perforation due to Chronic Graft versus Host Disease; a Clinicopathologic Report

Mehrdad Mohammadpour  1 , Siamak Maleki  1 , Hassan Hashemi  2 , Amir Houshang Beheshtnejad  1
Affiliations
Case Reports

Recurrent Corneal Perforation due to Chronic Graft versus Host Disease; a Clinicopathologic Report

Mehrdad Mohammadpour et al. J Ophthalmic Vis Res. 2016 Jan-Mar.

Abstract

Purpose: To describe a case of chronic graft versus host disease (GVHD) leading to severe dry eye and recurrent corneal perforation in both eyes, its stepwise management and histopathological reports.

Case report: A 22-year-old woman with a history of thalassemia and subsequent high-dose chemotherapy followed by allogeneic bone marrow transplant (BMT) was referred to Farabi Eye Hospital. Despite aggressive medical and surgical intervention, corneal vascularization in her right eye progressed and led to corneal perforation. Cyanoacrylate glue was applied to seal the perforation, however it recurred. Multilayer amniotic membrane transplantation (AMT) was performed to seal the corneal perforation, which was effective for a short period. Subsequently, the corneal perforation recurred and penetrating keratoplasty was performed. After a few months deep vascularization and descemetocele occurred in the fellow left eye and the patient finally underwent therapeutic lamellar keratoplasty.

Conclusion: Patients with GVHD are at risk of severe dry eye and subsequent corneal vascularization. Recurrent and recalcitrant corneal perforation resistant to cyanoacrylate glue and multilayer AMT may occur. Proper systemic and ocular management alongside close collaboration with the hematologist is strongly recommended to control the condition.

Keywords: Corneal Perforation; Corneal Ulcer; Dry Eye; Graft-versus-host disease.

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Figures

Figure 1
Figure 1
Slit lamp photograph of the right eye. The pupil is dilated and slightly displaced superiorly and the anterior chamber is slightly shallow. There is an opaque corneal ulcer with gray edges. The iris is tented forward and adherent to the perforation site. Corneal vascularization is evident in the paracentral and inferotemporal areas.
Figure 2
Figure 2
Appearance of the same eye as in Figure 1, after multilayer amniotic membrane transplantation (graft and patch) to seal the corneal perforation.
Figure 3
Figure 3
The corneal perforation remained sealed after resorption of the amniotic membrane.
Figure 4
Figure 4
Recurrent corneal perforation developed three months after amniotic membrane transplantation.
Figure 5
Figure 5
Appearance of the right eye one week after penetrating keratoplasty together with a deep intrastromal injection of bevacizumab.
Figure 6
Figure 6
Photomicrograph displaying different histopathological changes involving the cornea: corneal vascularization (a), corneal intrastromal inflammation (b), stromal corneal edema (c), and stromal corneal degeneration (d).
Figure 7
Figure 7
Appearance of the left eye, three years following therapeutic lamellar keratoplasty and a deep intrastromal injection of bevacizumab.
See this image and copyright information in PMC

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