|LETTER TO EDITOR
|Year : 2015 | Volume
| 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 Publication||20-Aug-2015|
103, 2-C, Asmita Mogra Co-operative Housing Society, Sherepunjab, Andheri (East), Mumbai-400 093, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ramakrishnan M. Healed keratitis with regression of high myopia. J Clin Ophthalmol Res 2015;3:163-4
Most of the times, corneal scar following treatment of infectious keratitis is associated with poor visual outcome, especially if it is dense, central/paracentral. , 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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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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| References|| |
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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.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]