Download Bilateral Corneal Trophic Ulcers and Subsequent Infectious Keratitis

Bilateral Corneal Trophic Ulcers and
Subsequent Infectious Keratitis in a
Patient with Graft-versus-host
Disease
Yonca Aydın Akova, MD
Bayındır Hospital,
Ankara, Turkey
Financial interest Alcon, Allergan, Bausch& Lomb, Thea, Deva
Purpose
• To report the clinical picture, complications
and therapeutic approach in a patient with
chronic graft versus host disease (GVHD)
Case Presentation
• 54-year-old men with
chronic myeloid leukemia
• Bone marrow
transplantation
• He developed chronic GVHD
– Severe dry eye, Schirmer test
without anesthesia 1 mm,
OU
– Bilateral trophic corneal
ulcers involving the whole
cornea
– Crystalline keratopathy in the
right eye
Therapy
• Topical therapy
– Autologous serum
50 %
– Unpreserved topical
steroids 3x1
– Topical cyclosporine
A, 0.05% 4x1
– Unpreserved
artificial tears 8x1
• Therapeutic soft
contact lenses
• Silicone punctum
plugs
• Systemic therapy
– Doxycyline
– Prednisolone
– Immunosuppressive
therapy (mycofenolate
and cyclosporine )
– Photopheresis
Clinical Findings
• Bacterial ulcer with
hypopyon in the left
eye
• Conjunctival and
corneal cultures
negative
• Response to topical
fortified vancomycine
and ceftazidime
therapy
Bacterial keratitis with hypopyon
Clinical Findings
One months later
• Multiple corneal
infiltrates, OD
• Cultures were positive
for candida albicans
• Response to topical
amphotericin B and
topical voriconazole 1%
therapy
Candida keratitis with multiple infiltrates
Clinical Findings
• Infectious crystalline
keratopathy and
satellite infiltrates
caused by candida
albicans in the right
eye
Satellite infiltrates
After Treatment
Clinical Findings
• Response to
topical
amphotericin B
and topical
voriconazole 1%
therapy
After Treatment
Conclusions
• Patients with chronic GVHD may develop
severe inflammatory changes in the ocular
surface
– Severe dry eye
– Persistent trophic ulcers
– Infectious keratitis
• Bacterial keratitis
• Fungal keratitis
Conclusions
• Crystalline keratopathy may develop due to
corneal infections
• Microbial causes include not only bacteria
but fungi as well
• GVHD patients should be carefully evaluated
for such severe complications in order to
start the appropriate treatment timely