PMC5745696_01
Clinical appearance of the patient before surgery. Please note a corneal perforation surrounded by a dense infiltrate (A) associated with inferior neovascularization (B).
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fig1
There was an almost complete shallowing of the anterior chamber and a cataract (Figure 1).
Simultaneous noncentered photoactivated chromophore for keratitis-corneal collagen cross-linking (PACK-CXL) and penetrating keratoplasty. (a) Corneal trephination. (b) Cornea removal. (c) Open-sky cataract removal. (d) Intraocular lens implantation. (e) Donor cornea suturing. (f) Riboflavin impregnation.
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fig2
Surgery (Figure 2) was performed by one of the authors (K.B.) under general anesthesia: donor and receptor corneas were cut with an 8.50 mm and 8.00 mm trephine, respectively.
Cross-linking lamp used for the treatment of the patient (UV-X 2000, Avedro Inc., Waltham, United States).
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Irradiation with ultraviolet was performed with a CXL machine (UV-X 2000 , Avedro Inc., Waltham, United States) (Figure 3) for ten minutes, aiming for an energy dose of 9 mW/cm2.
Schematic representation of the areas of the eye covered by the penetrating keratoplasty procedure (blue circle, 8 mm) and the noncentered PACK-CXL (green circle, 7 mm).
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UV irradiation beam was positioned so that it included part of the donor cornea, the whole infected receptor cornea, affected limbus, and a small part of sclera (Figure 4).
Clinical appearance of the patient three weeks after surgery. Note some natamycin over the eye.
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Due to the patient's economic status and insurance, he could only start antibiotic and antifungal treatment about 21 days after surgery (Figure 5).
Clinical appearance of the patient two months after surgery, showing a complete resolution of infection, with conjunctivalization replacing the area that was infected in the receptor rim.
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During the follow-up period (over four months) the patient has shown an excellent recovery; his eye inflammation has been as expected for a penetrating keratoplasty, and no clinical signs of infection recurrence have been noted (Figure 6).