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A modified Tenons sling annular graft for advanced peripheral ulcerative keratitis with an hourglass cornea
Venugopal Anitha1, Aditya Ghorpade2, Meenakshi Ravindran3
1Department of Cornea, Ocular Surface, Trauma and Refractive Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India.
Abstract:
Systemic tuberculosis mostly affects the lungs and ocular involvement is rare. The ocular manifestations are varied, and rarely peripheral ulcerative keratitis (PUK) occurs either due to direct invasion of the microorganism or due to immune reaction. We present a case of advanced PUK in a 28-year-old male patient diagnosed with pulmonary TB in the right eye with hourglass cornea. The ulcer was progressing circumferentially with necrosis of corneal stroma and undermined margins similar to Moorens ulcer, and was not responding to anti-tuberculosis treatment and topical steroids. We describe a modified novel surgical technique using tenons sling annular patch graft to manage the progressive advanced PUK with hourglass cornea to optimize visual and structural outcome in our patient.
Insights
Ocular tuberculosis is rare, but can cause severe peripheral ulcerative keratitis (PUK). A novel surgical technique using a tenons sling annular patch graft successfully managed advanced PUK with hourglass cornea in a TB patient.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Systemic tuberculosis (TB) primarily affects the lungs, with rare ocular manifestations.
- Ocular involvement in TB can present with varied clinical signs, including peripheral ulcerative keratitis (PUK).
- PUK in TB can result from direct microbial invasion or immune-mediated responses.
Observation:
- A 28-year-old male with pulmonary TB presented with advanced PUK in the right eye.
- The patient exhibited an hourglass cornea with circumferential stromal necrosis and undermined margins, resembling Mooren's ulcer.
- The condition was refractory to standard anti-tuberculosis therapy and topical corticosteroids.
Findings:
- A modified surgical technique employing a tenons sling annular patch graft was utilized.
- This novel approach aimed to manage the progressive PUK and hourglass deformity.
- The surgical intervention was performed to optimize both visual acuity and structural integrity of the cornea.
Implications:
- This case highlights a rare but severe ocular complication of systemic tuberculosis.
- The described surgical technique offers a potential solution for advanced PUK with hourglass cornea.
- Effective management of such complex cases requires a multidisciplinary approach combining medical and surgical interventions.
