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Scleral transplantation for corneal perforation due to keratitis Masamichi Kiriyama 1 , Hiroshi Toshida 1 , Tsubasa Komori 1 , Satoko Asaoka 1 , Kohei Ichikawa 1 , Jobu Sugita 1 , Toshihiko Ohta 1 , Shintaro Nakao 2 1Department of Ophthalmology, Juntendo University Shizuoka Hospital 2Department of Ophthalmology, Juntendo University School of Medicine pp.491-497
Published Date 2024/4/15
DOI https://doi.org/10.11477/mf.1410215149
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Abstract Purpose:We report a case of a 71-year-old man who had a history of hard contact lens misuse and presented with a refractory corneal ulcer. Despite multiple surgeries and treatment resistance, the patient developed corneal perforation. However, scar healing occurred after penetrating keratoplasty, and enucleation was avoided.

Case presentation:The patient was a 71-year-old male who had misused hard contact lenses. He was initially diagnosed with a right corneal ulcer by a local physician, for which he was prescribed antibiotics;however, as no improvement was seen, he was referred to our department as a new patient. At the initial visit, his visual acuity was hand motion(uncorrectable);further he presented with conjunctival congestion, a corneal ulcer, anterior chamber purulence, and corneal perforation. Although initial culture results were negative, fungal filaments were later detected in a smear examination, leading to the initiation of antifungal therapy. During the course of observation in which patient developed corneal thinning and perforation;this led to the performance of three separate conjunctival surgeries and one superficial corneal transplantation. Repeated suture dehiscence and corneal melting, led to the performance of penetrating keratoplasty as penetrating keratoplasty was performed as an alternative procedure, resulting in successful scar healing. At the two-year postoperative follow-up, the patient maintained a visual acuity of hand motion(uncorrectable).

Conclusion:When treatment with conjunctival flap surgery or superficial corneal transplantation is met with resistance in cases of refractory corneal ulcer with corneal thinning and perforation, penetrating keratoplasty may be considered as a viable treatment option. This case illustrates that penetrating keratoplasty can lead to scar healing in such challenging cases and prevent the need for enucleation.


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電子版ISSN 1882-1308 印刷版ISSN 0370-5579 医学書院

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