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Marie Passemard, Aurore Muselier, Brice Dugas, Alain M Bron, Catherine Creuzot-Garcher; Severe Corneal Complications Following Vitreoretinal Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):535.
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To report severe corneal complications associated with vitreoretinal surgery.
We conducted a retrospective, interventional case series in one academic center. Above 650 vitreoretinal surgeries were performed during one year, and the chart of 9 eyes from 9 patients were analyzed. Data included gender, age, reasons for ocular surgery, surgical procedure, history of diabetes mellitus, herpes simplex virus keratitis, keratoconjunctivitis sicca, corneal epithelium peeling during the surgical procedure, use of perfluorodecalin or silicon oil, postoperative use of concurrent topical steroidal (SAIDs) and non-steroidal anti-inflammatory drugs (NSAIDs), evaluation of corneal esthesia, time allowed from the initial surgery, medical and surgical treatment of the ulcerations.
Out of the nine patients, eight surgeries were performed under peribulbar anesthesia (five for vitreoretinal surgery, three for combined cataract and vitreoretinal surgery), and one under general anesthesia (for vitreoretinal surgery). Patient ages ranged from 53 to 83 years (mean, 68.8±10.1 years). Mean final visual acuity after surgery increased from 1.81±0.6 to 1.7±0.9 LogMAR. Mean ulceration’s time allowed from the initial surgery was 24±26.6 days. Five patients had diabetes mellitus, and five patients had corneal epithelium peeling during the surgical procedure. Five patients referred for corneal complications were already using concurrent topical NSAIDs and SAIDs, one was using topical antibiotics (ABs), valacyclovir and tarsorraphy, one was treated with topical ABs, NSAIDs, SAIDs and antiseptic, one with topical NSAIDs and ABs, and one with topical NSAIDs. All of these medications were stopped because of their potentiate surface toxicity. Eight patients presented a corneal hypoesthesia. The following were diagnosed: one ocular rosacea, one ocular cicatricial pemphigoid, and one herpetic kerato-uveitis. Corneal sequelae were: 4 corneal infiltrates, 3 superficial punctuate keratopathy and corneal melt, and 2 corneal decompensations.
Because of the risk of developing corneal ulcers, patients with diabetes mellitus, keratoconjunctivitis sicca or corneal epithelium peeling during the surgical procedure, should be followed closely after ocular surgery. The surgeon should treat the dry eye and use as little topical concurrent NSAIDs and SAIDs as possible to suppress postoperative inflammation and to avoid toxicity.
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