Non-traumatic corneal perforation in HIV immunosuppressed patients. Case series of 4 patients
Main Article Content
Abstract
Introduction:
Non traumatic corneal perforations come as a result of tissue destruction from infectious and non infectious causes. Immunosuppression from HIV can lead to thinning of the cornea and can also cause sterile and non-sterile spontaneous corneal perforations. We are reporting a series of 4 cases of corneal perforation in HIV immunosuppressed patients.
Clinical presentation:
Case 1: Mrs. F E, a 27year old farmer presented with complain of left eye discharges of one-week duration. No history of previous eye diseases. On eye examination, visual acuity was counting finger 1m left eye.4 days later an inferonasal corneal perforation from a ruptured descemetocele was seen. HIV serology done was positive. The management was conservative.
Case 2: Mr. M D.26 years old, presented with sudden onset of decreased vision in the left eye of 6 days duration. Eye examination showed a visual acuity of counting fingers and an epithelial defect localized inferiorly, which was ovoid. The ulcer perforated 4 days later. HIV test was positive and the defect was managed with a bandage contact lens and patient started on ART.
Case 3: BB N, 13 months old boy, informant mother, who complained of the child was noticed to have swollen eyes, associated with purulent discharges for one month. On ocular examination; Visual acuity NCNSNM in both eyes; there was an infero- temporal perforation in the right eye and in left eye a central cornea abscess with a leaking descemetocele. HIV test was positive. The initial management was conservative.
Case 4: Mr. B D. 50 years old, who presented with redness of the left eye of 3 months duration. He was a known seropositive on ARVs. Last CD4 count was 400/mm3. He had use traditional eye medication. On ocular examination, visual acuity was light perception in the left eye. The anterior segment examination in the left eye showed corneal changes with a descemetocele inferiorly and an infected ulcer at the inferior ¾ of limbus (endophthalmitis). The management was evisceration.
Conclusion: Immunosuppression from HIV is a risk factor for spontaneous corneal perforation and should be routinely done and managed accordingly.
Key words: Perforation, HIV, cornea.
Article Details
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References
2. Epee E, Kamgaing N, Mvilongo C, Bella A, Ebana C, Koki G, et al. Perforation cornéenne bilatérale spontanée chez un nourrisson immunodéprimé au VIH : à propos d’un cas. J Fr Ophtalmol [Internet]. 2014;37(9):e141–3.
3. Baranwal VK, Kumar S, Mishra A, Satyabala K, Dutta AK, Murthy PK. Bilateral sterile perforated corneal ulcer in an HIV case. Med journal, Armed Forces India 2015;71(Suppl 1):S26-8.
4. honig MA RC. management of corneal perforations. Vol. 3, cornea. 1997. 1815-1832 p.
5. Foster A, Sommer A. Corneal ulceration, measles, and childhood blindness in Tanzania. Br J Ophthalmol. 1987;71(5):331–43.
6. Abouzeid H, Majo F, Gianoli F, Guex-Crosier Y. Segment antérieur : Perforation cornéenne causée par Neisseria gonorrhoeae et Ralstonia CDC groupe IV c-2 chez un patient VIH positif. http://www.edimark.fr/Front/frontpost/getfiles/14968.pdf
7. Panda A, Kumar S, Kumar A, Bansal R, Bhartiya S. Fibrin glue in ophthalmology. Indian J Ophthalmol. 2009 ;57(5):371–9.
8. Vasseneix C, Toubeau D, Brasseur G, Muraine M. Prise en charge chirurgicale des perforations cornéennes non traumatiques : étude rétrospective sur 8 ans. J Fr Ophtalmol 2006 ;29(7):751–62.