Pyoderma gangrenosum with necrotizing sclerokeratitis after cataract surgery

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Pierre Fournié1, François Malecaze, Julien Coullet

  • 1Centre Hospitalier Universitaire Toulouse, Hôpital Purpan, Service d'Ophtalmologie, Toulouse, France. pierrefournie@yahoo.com

Journal of Cataract and Refractive Surgery
|October 30, 2007
PubMed

Insights

This case report details a rare instance of pyoderma gangrenosum (PG)-associated peripheral ulcerative keratitis (PUK) occurring after cataract surgery. Prompt recognition and treatment are crucial for managing this sight-threatening condition.

Area of Science:

  • Ophthalmology
  • Dermatology
  • Immunology

Background:

  • Cataract surgery can rarely trigger ocular complications.
  • Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with potential systemic associations.
  • Peripheral ulcerative keratitis (PUK) is a severe corneal inflammation often linked to systemic autoimmune diseases.

Observation:

  • A 78-year-old man developed painful PUK at the cataract surgery incision site three months post-operation.
  • The patient had a 13-year history of PG associated with monoclonal immunoglobulin-A gammopathy.
  • The PUK presented with a descemetocele, indicating a high risk of corneal perforation.

Findings:

  • Fibrin glue was used to stabilize the corneal ulcer.
  • Treatment included tapering corticosteroids, cyclophosphamide, and high-dose intravenous immunoglobulin.
  • The corneal ulcer healed within one month, but with significant visual acuity loss.

Implications:

  • This is the first reported case of PG-associated sclerokeratitis following cataract surgery.
  • Early diagnosis of ocular PG is vital for timely and appropriate management.
  • This case highlights the importance of considering PG in patients with unexplained PUK after ocular surgery.

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