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    Dr. Amel - Corneal Ulcer With Descemetocele

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    Finty Arfian
    This case report describes a 77-year-old man presenting with a corneal ulcer and descemetocele in his left eye. His right eye had been blind for 20 years from a similar condition. Examination found a 3x3mm descemetocele and hypopion in the left eye. He was treated with antibiotics, anti-inflammatories, and cryotherapy was performed to treat the descemetocele and prevent perforation. The left eye showed some improvement in vision but the right eye remained blind.

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    Dr. Amel - Corneal Ulcer With Descemetocele

    Uploaded by

    Finty Arfian
    171 views35 pages
    This case report describes a 77-year-old man presenting with a corneal ulcer and descemetocele in his left eye. His right eye had been blind for 20 years from a similar condition. Examination found a 3x3mm descemetocele and hypopion in the left eye. He was treated with antibiotics, anti-inflammatories, and cryotherapy was performed to treat the descemetocele and prevent perforation. The left eye showed some improvement in vision but the right eye remained blind.

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    Corneal Ulcer With Descemetocele

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    This case report describes a 77-year-old man presenting with a corneal ulcer and descemetocele in his left eye. His right eye had been blind for 20 years from a similar condition. Examination found a 3x3mm descemetocele and hypopion in the left eye. He was treated with antibiotics, anti-inflammatories, and cryotherapy was performed to treat the descemetocele and prevent perforation. The left eye showed some improvement in vision but the right eye remained blind.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    171 views35 pages

    Dr. Amel - Corneal Ulcer With Descemetocele

    Uploaded by

    Finty Arfian
    This case report describes a 77-year-old man presenting with a corneal ulcer and descemetocele in his left eye. His right eye had been blind for 20 years from a similar condition. Examination found a 3x3mm descemetocele and hypopion in the left eye. He was treated with antibiotics, anti-inflammatories, and cryotherapy was performed to treat the descemetocele and prevent perforation. The left eye showed some improvement in vision but the right eye remained blind.

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    CASE REPORT

    CORNEAL ULCER
    WITH
    DESCEMETOCELE
    AMELIA SAFITRI RAMADHANI, MD
    INTRODUCTION
    Background

     Corneal ulcer is defined as a disruption of the


    epithelial layer with involvement of the corneal
    stroma (Reddy et al., 2005)
     Cornealulcers have the potential to cause
    devastating loss of vision, often rapidly (Tuli,
    Sonal, 2012)
     Cornealulcers are the second most-common cause
    of preventable blindness after cataract in tropical
    developing country (Bandyopadhyay, et al., 2012)
    PURPOSE

     Tofurther study the management of


    corneal ulcer to reduce the development
    of its complications
    REVIEW ARTICLE
    ANATOMY OF CORNEA

    (Vaughan dan Asbury, 2010)


    PATHOPHYSIOLOGY

    (Bhavsar, Yogini, 2010)


    Most common pathogens : Bacteria
    Pseudomonas aeruginosa
    Staphylococcus aureus
    Streptococci
    Guidelines for the Management of Corneal Ulcer, WHO
    2004
    Treatment for Uncomplicated Corneal
    Ulcer

     Specific treatment for the cause


    Local and systemic antibiotics
     Non-specific supportive therapy
    Cycloplegic drugs, systemic analgesics and anti-
    inflammatory drugs, vitamins
     Physical and general measures
    Hot fomentation, pad and bandage, rest, and good diet

    Khurana AK, 2007


    Treatment for Non-Healing Corneal
    Ulcer

     Removal of any known cause of non-healing


    ulcer
     Mechanical debridement of ulcer to remove
    necrosed material by scraping floor of the ulcer
    with spatula
     Cauterisation of the ulcer
     Peritomy
    Treatment for Impending Perforation

     No strain. The patient should be advised to


    avoid sneezing, couging, and straining during
    stool etc.
     Pressure bandage
     Lowering of IOP
     Tissue adhesive glue such as cynoacrylate
     Conjunctival flap
     Bandage soft contact lens
     Penetrating therapeutic keratoplasty
    Treatment for Perforated Corneal
    Ulcer

     Depending upon the size of perforation and


    availability, measures like use of tissue adhesive
    glues, covering with conjunctival flap, use of bandage
    soft contact lens or therapeutic keratoplasty should be
    undertaken. Best is an urgent therapeutic
    keratoplasty
    CASE
    PRESENTATION
    IDENTITY

     Name : Mr. Gimun


     Age : 77 years old
     Address : Bluru Kidul, Sidoarjo
    ANAMNESIS
     Chief complaint : appearance of the black spot and pus on
    the LE
     The patient and his daughter came to the outpatient
    clinic and complained about the appearance of a black
    spot and pus on the LE, followed by ocular pain and
    tearing since one day before. The patient’s daughter also
    complained about the appearance of white matter on the
    patient’s LE since 2 months, followed by redness of LE
    and blurred vision.
     Hospitalized in BKMM for two times (on November and
    early December 2014) and referred into RSUD dr.
    Soetomo on December 23rd – 29th 2014 because of the
    HISTORY OF PAST ILLNESS

     RE was blind since 20 years ago, with the


    same symptoms as the current LE. The
    patient said that the doctor was performed a
    surgery, but he doesn’t remember what kind
    of surgery. Since that time, the RE was blind.
     No history of DM, Hipertension
    PHYSICAL EXAMINATION

     Visual Acuity

     Right Eye : LP -

     Left Eye : 1/300 (hand movement)

     Intraocular Pressure

     Right Eye : Can’t be evaluated

     Left Eye : Can’t be evaluated


    ANTERIOR
    RIGHT EYE LEFT EYE
    SEGMENT
    Ptysis Bulbi (+)
    Edema -, Spasm - Palpebra Edema -, Spasm -
    Hyperemia +
    Hyperemia +
    Conjunctiva Subconjunctival
    (minimal)
    bleeding (+)
    Hazy +, Fl test was
    Hazy +, Fl test +, not performed,
    Cornea
    Neovascularization + Descemetocele +,
    Neovascularization +
    Anterior
    Difficult to be Hypopion ½ of the
    Chamber
    evaluated anterior chamber
    Depth
    Difficult to be Difficult to be
    Iris
    evaluated evaluated
    Difficult to be Difficult to be
    Pupil
    evaluated evaluated
    Difficult to be Difficult to be
    Lens
    evaluated evaluated
    FUNDUSCOPY

    RIGHT EYE LEFT EYE


    Can not be Can not be
    evaluated evaluated
    SCRAPPING (January 21st, 2015)

     PMN : many
     MN : few
     Bacteria : negative
     KOH : negative
    ULTRASONOGRAPHY (January 22nd, 2015 by Sauli Ari, MD.
    Ophthalmologist)

     Conclusion: PVD
    LABORATORY & RADIOLOGY
    FINDINGS (January 23rd, 2015)

     Kalium
    : 2,7 mmol/L (N: 3,5 – 5,5
    mmol/L)

     Chest
    X-Ray : Cardiomegaly with
    prominent aortic knob
    CONSULTATION

     Cardiology Dept.
    Saat ini di bidang Kardiologi kami dapatkan pasien dengan hipertensi
    stage I JNC VII tanpa tanda gagal jantung akut. Saran: Amlodipine 5mg
    –0–0
     Internal Medicine Dept.
    Saat ini di bidang IPD jami dapatkan penderita dengan hipokalemia
    dengan penyebab yang masih memerlukan evaluasi. Saran :
    1.Diet TKTP 2100 Kkal/hari ekstra buah
    2.Koreksi dengan drip KCl 25 meq dalam PZ 500 cc selama 12 jam
    3.KSR 3x1 tablet
    4.Tidak ada kontraindikasi untuk dilakukan tindakan di bidang TS
    TEMPORARY PROBLEM LIST

     Black spot and pus on the LE


     LE ocular pain and tearing
     White matter on the black part of the LE since 2 months ago, followed by
    redness of the LE and blurred vision
     Blind RE since 20 years ago, with the same symptom as the LE
     Visual acuity of RE : LP (-) and LE : 1/300 bad projrction illumination
     conjunctival hyperemia on the left eye, hazy left eye’s cornea due to the
    infiltration, thinning process as descemetocele, and neovascularization on the
    left eye’s cornea, also hypopion within the left eye’s anterior chamber
     Iris prolapse on the 6th day
     USG : LE PVD
    PERMANENT PROBLEM LIST

     LECorneal Ulcer with Hypopion + Descemetocele + Iris


    Prolapse
     RE Blind Eye
    DAILY FOLLOW UP
    January 21st, 2015

    VISUAL ACUITY
    RE : LP (-) LE : 1/300 bad PI
    LE anterior segment : Descemetocele 3 x 3
    mm
    Hypopion ½ of anterior
    chamber
    Advice from Randi Montana, MD.
    Ophthalmologist:
    • Hospitalized
    • Ceftriaxone 2x1 gram i.v.
    • Na Diclofenac 2x50 mg p.rn.
    • Vigamox e.d. ½ jam dd gtt I OS
    • Tobramycin e.d. OH dd gtt I OS
    • Atropin e.d. 2 dd gtt I OS
    • Suspect bacterial infection
    January 23rd, 2015

    VISUAL ACUITY
    RE : LP (-) LE : LP (+)
    LE anterior segment : Descemetocele (+) 3 x 5 mm
    Hypopion ½ of anterior chamber
    Advice from Eddyanto, MD. Ophthalmologist
    Prepare for the LE Cryotherapy + AMT + BCL (on January
    27th, 2015)
    January 25th, 2015

    VISUAL ACUITY
    RE : LP (-) LE : LP (+)

    LE anterior segment : Descemetocele (+) 3 x 5


    mm
    Hypopion 1/5 of anterior
    chamber
    January 26th, 2015

    VISUAL ACUITY
    RE : LP (-) LE : LP (+)

    LE anterior segment : Descemetocele (+) 3 x 5 mm


    Hypopion (-)

    Result from gram staining and aerobic culture : no


    pathogen was found
    VISUAL ACUITY
    RE : LP (-) LE : LP (+)

    LE anterior segment : Descemetocele (+) 3 x 5


    mm
    Iris prolapse (+)
    Hypopion (-)
    LE AMT + CRYOTHERAPY + BCL
    POST OPERATIVE TREATMENT

     Chloramphenicol 3 x 500 mg
     Vigamox e.d. ½ OH dd gtt I OS
     Tobro e.d. OH dd gtt I OS
     Na Diclofenac tab. 2 x 50 mg p.c.
     Eye tapping and bandage (can be opened after three days)
    THANK YOU

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