Whole Corneal Descemetocele

Abstract

Background and Objectives: To report a case of microbial keratitis complicated by severe corneal melting and whole corneal descemetocele. Methods: A 72-year-old male farmer presented with a right corneal ulcer involving nearly the entire cornea, which was almost completely melted down with the remaining Descemet's membrane (DM). The pupil area was filled with melted necrotic material, with the intraocular lens partially protruding from the pupil and indenting the DM. Corneal optical coherence tomography (OCT) examination revealed a corneal thickness of 37 µm that was attached to its back surface, with the iris and a part of the intraocular lens (IOL) protruding through the pupil. The patient was hospitalized and treated with local and systemic antibiotics until control of the inflammation was achieved. Corneoscleral transplantation plus excision/transplantation of the corneal limbus were performed, and the entire corneal limbus was lamellarly incised. After completely suturing all around the transplanted corneoscleral graft, the anterior chamber was formed. Postoperative treatment included local antibiotics, anti-inflammatory drugs, and cycloplegic drops. Results: There was no recurrence of infection, and the corneal epithelium gradually regenerated and covered the whole graft. Visual acuity was light perception at 6 months after the surgery. The patient was satisfied that the globe was preserved and did not wish to undergo any further treatment. Conclusions: Corneoscleral transplantation is preferred for the treatment of large-sized descemetoceles with active microbial keratitis and extensive infiltrates, especially in cases where the whole cornea has transformed into a large cyst.

Keywords: descemetocele; microbial keratitis; penetrating keratoplasty (PRP).

Figure 1

The right cornea showed a large centrally infected ulcer with grayish-whitish infiltration involving the central cornea and extending to the lower periphery (A). The corneal ulcer and infiltration after two weeks of the first visit (B). The right whole cornea descemetocele after three weeks of the first visit (C).

Figure 2

The right corneal ulcer stained greenish with fluorescein, involving nearly the whole cornea, which was almost completely melted down with the remaining DM (A). Descemetocele (yellow arrows) protruding forward, the pupil area was filled with melted necrotic material (star), and the intraocular lens was partially protruding from the pupil and indenting the DM (white arrow) (B). The vertical corneal optical coherence tomography (OCT) examination revealed 37 µm of corneal thickness attached to its back surface with the iris (star) and part of the IOL (white arrow) was protruding through the pupil and indenting the DM (yellow arrows) (C,D).

Figure 3

Right corneal descemetocele (yellow arrows) showed resolution of ulceration and infiltration except for a few scattered greenish spots stained with fluorescein (white arrows) (A,B). Right eye after corneoscleral transplantation (C). Vertical OCT of the right eye after corneoscleral transplantation (white arrow) with the formation of the anterior chamber (star) (D).