PMC5010152_01
(A) Left eye at first evaluation. (B) 50th DOI: the beginning of the infiltrate (black arrow) accumulation.. Abbreviation: DOI, day of infection.
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A bandage contact lens (CL) was placed, and tobramycin 0.3% (Tobrex ; Alcon Brazil, Sao Paulo, SP, Brazil) and moxifloxacin 0.5% (Vigamox ; Alcon Brazil) were prescribed for a period of 4 weeks, until total closure of the cornea injury and negative Seidel test (Figure 1A). In addition, central pigmentation and feathery margins were found, as well as a shallow anterior chamber and a positive Seidel test (Figure 1B).
(A) 60th DOI: the infiltrate's progression and the hypopyon. (B) 70th DOI. Note: Black arrow: infiltrate; white arrow: hypopyon.. Abbreviation: DOI, day of infection.
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A marked increase in temporal limbal injection, a 2 mm hypopyon, and increased density of the infiltrate at the recipient border (Figure 2A) were observed on the 60th DOI. In addition, the hypopyon occupied half of the anterior chamber (Figure 2B).
(A) 85th DOI: improvement in the infiltrate size and the hypopyon. (B), 140th DOI. Note: (A, B) black arrow: infiltrate; (B) white arrow: new infiltrate.. Abbreviation: DOI, day of infection.
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On the 85th DOI, the patient experienced significant reduction in redness and pain, and there was a decrease in infiltrate density and size (to 4.6x2.5 mm), negative Seidel test results, and no hypopyon (Figure 3A). However, a new infiltrate measuring 2.5x1.7 mm2, forming a white opacity with the aspect of small needles and without surrounding inflammation or edema, was observed in the anterior stromal third of the graft, which made the assistant ophthalmologist think on the possibility of ICK (Figure 3B).
(A) Regraft at the sixth PO day. (B) Regraft at the sixth PO month.. Abbreviation: PO, postoperative.
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The graft was clear and exhibited no signs of active inflammation or infection (Figure 4A). The final follow-up, which occurred at the sixth PO month (Figure 4B), revealed a clear graft, no signs of recurrence, and an uncorrected VA value of 20/200.