Niestrata Magdalena, Saleki Mohammad, Ashena Zahra
Ophthalmology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR.
Cureus. 2024 Jun 16;16(6):e62463. doi: 10.7759/cureus.62463. eCollection 2024 Jun.
A patient in his 60s presented with severe keratitis in his right eye. He had a background of diabetes, high body mass index, arthritis and limited mobility, and high alcohol intake. Examination showed lower lid tarsal ectropion, floppy eyelid syndrome, advanced meibomian gland dysfunction, moderate neurotrophia, and large inferior keratitis with hypopyon. Corneal scrapes revealed , sensitive to vancomycin and ciprofloxacin only. Due to poor compliance with vancomycin, he was started on topical ciprofloxacin resulting in partial improvement but a persistent epithelial defect. Inserting a dry patch of amniotic membrane on the cornea accelerated epithelialization, and 11 weeks from presentation, complete corneal healing was noted. In the presence of multiple systemic and ocular risk factors like diabetes, high body mass index, high alcohol intake, tarsal ectropion, floppy eyelid syndrome, neurotrophic cornea, blepharitis, and ocular surface inflammation, atypical keratitis, like this rare infection, should be suspected. The use of dry amniotic membrane has a role in epithelial healing in patients with neurotrophia.
一名60多岁的患者右眼出现严重角膜炎。他有糖尿病、高体重指数、关节炎、行动不便以及大量饮酒史。检查发现下睑睑板外翻、眼睑松弛综合征、睑板腺功能障碍晚期、中度神经营养不良以及伴有前房积脓的下方大角膜炎。角膜刮片显示仅对万古霉素和环丙沙星敏感。由于对万古霉素依从性差，他开始使用局部环丙沙星，病情有部分改善，但上皮缺损持续存在。在角膜上植入一片干燥羊膜加速了上皮化，就诊11周后，角膜完全愈合。在存在糖尿病、高体重指数、大量饮酒、睑板外翻、眼睑松弛综合征、神经营养性角膜、睑缘炎和眼表炎症等多种全身和眼部危险因素的情况下，应怀疑存在这种罕见感染等非典型角膜炎。干燥羊膜的使用在神经营养不良患者的上皮愈合中发挥作用。
