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EE Gabison, P Chastang, S Menashi, M Oster, A Mauviel, T Hoang-Xuan; Corneal Perforation Following Photorefractive Keratectomy And Prolonged Use Of Diclofenac . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1691.
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Purpose: To report the first case of corneal perforation following PRK and to investigate for predisposing factors Methods: A 50-year-old man with a past history of well controlled diabetes mellitus underwent PRK in his right eye in July 2001. The patient was referred to our clinic for a corneal perforation two months postoperatively on his treated eye . An examination including medical and ophthalmic history, visual acuity, biomicroscopy was performed as well as an histological and immuno-histochemical examination (for extracellular matrix molecules) of the corneal button. Results: Slit-lamp examination revealed a 5-mm central corneal haze with a 4-mm diameter corneal thinning and a 2-mm central perforation. Predisposing factors of this failure of wound healing included prolonged topical diclofenac therapy (for more than two months) and the past history of well-controlled diabetes mellitus for the past 10 years. Systemic antibiotherapy was administered and penetrating keratoplasty subsequently performed. Histological examination of the corneal button revealed a central perforation associated with a large area of stromal thinning. Additional findings included an epithelial hyperplasia and an inflammatory cell infiltration located in the anterior stroma. Immunohistological analysis revealed an intense staining for collagen type III in the area of stromal thining associated with a discontinued staining for collagen type IV especially at the Descemet's membrane level. Conclusion:Prolonged use of diclofenac and diabetes mellitus may have concurred to induce this corneal perforation following PRK. Use of topical non-steroidal anti-inflammatory drugs should be carefully monitored and limited to the first days postoperatively, particularly in patients at risk of poor wound healing.
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