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LETTER TO EDITOR
Year : 2015  |  Volume : 3  |  Issue : 3  |  Page : 163-164

Healed keratitis with regression of high myopia


Department of Ophthalmology, Karamshi Jethabhai Somaiya Medical College and Research Centre, Sion, Mumbai, Maharashtra, India

Date of Web Publication20-Aug-2015

Correspondence Address:
Minu Ramakrishnan
103, 2-C, Asmita Mogra Co-operative Housing Society, Sherepunjab, Andheri (East), Mumbai-400 093, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.163306

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How to cite this article:
Ramakrishnan M. Healed keratitis with regression of high myopia. J Clin Ophthalmol Res 2015;3:163-4

How to cite this URL:
Ramakrishnan M. Healed keratitis with regression of high myopia. J Clin Ophthalmol Res [serial online] 2015 [cited 2022 Jan 26];3:163-4. Available from: https://www.jcor.in/text.asp?2015/3/3/163/163306

Sir,

Most of the times, corneal scar following treatment of infectious keratitis is associated with poor visual outcome, especially if it is dense, central/paracentral. [1],[2] We report a case of contact lens (CL)-induced paracentral bacterial keratitis, which healed well with regression of high myopia to near emmetropia.

An 18 year old female presented to our outpatient department with redness, pain, and watering of the left eye (LE) since past 3 days. Patient was a high myope, using spectacles of -9.0 diopter (D) both eyes (BE), and a regular CL user. She had a 2 × 3 mm paracentral superficial corneal ulcer, with surrounding infiltrate. Gram positive cocci were seen on staining the scraping from the ulcer, and it was confirmed as CL-induced keratitis on culture of CL case and solution. Patient was treated with broad spectrum antibiotics and cycloplegic for 10 days, and then topical loteprednol was added once healing started. At the end of 1month, after complete resolution of the ulcer, patient was started on Bell Diono Resolvent for another 15 days to reduce and limit scarring.

Patient was on regular follow-up. At 3-month follow-up, the patient reported unexpected improvement in uncorrected visual acuity (UCVA) in the affected eye, and worsening of vision in the same eye with previous glasses. On refraction, we were surprised to find UCVA of 6/12 in the LE, with no acceptance of trial glasses. Right eye showed similar refraction of -9.0 D as previously noted. Patient was advised to use disposable CLs only for the right eye and regular follow-up.

At 1-year follow-up, the paracentral scar was clearly visible [Figure 1] and [Figure 2]. She had an UCVA of 6/9 in the LE, with refraction showing irregular astigmatism of 0.5-0.75 D, with no acceptance of trial glasses. The right eye was status quo.
Figure 1: Faint nebular scar in paracentral cornea on slit-lamp-diffuse illumination

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Figure 2: Parallelopiped slit image of the scar

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Recently, at 2-year follow-up, she had maintained the same refractive status. She was posted for laser-assisted in situ keratomileusis (LASIK) for the right eye. On Orbscan, LE [Figure 3], apart from the flattening due to the scar, showed an area of thinning inferiorly, especially on posterior float, suggestive of formefruste keratoconus while RE showed a normal posterior float [Figure 4]. She underwent uneventful LASIK for the right eye, and has good binocular vision. Considering the formefruste keratoconus in the LE, she would have been a poor candidate for LASIK in that eye; but luckily for her, the CL-induced keratitis and residual scar turned out to be a blessing in disguise.
Figure 3: Orbscan of left eye showing flattening at the region of the scar, with associated inferior formefruste keratoconus

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Figure 4: Orbscan of right eye

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  References Top

1.
Keay L, Edwards K, Naduvilath T, Taylor HR, Snibson GR, Forde K, et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology 2006;113:109-16.  Back to cited text no. 1
    
2.
Holden BA, Sweeney DF, Sankaridurg PR, Carnt N, Edwards K, Stretton S, et al. Microbial keratitis and vision loss with contact lenses. Eye Contact Lens 2003;29:S131-4.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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