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Corneal Perforation Two Years After Mitomycin Intravascular Chemoembolization
Trakanta Wannapanich1, Raven Diacou, Vishal Jhanji
1Department of Ophthalmology (T.W.), Center of Excellence for Cornea and Stem Cell Transplantation, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Ophthalmology (T.W.), Excellence Center for Cornea and Stem Cell Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; and Department of Ophthalmology (R.D., V.J.), UPMC Vision Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Abstract:
Mitomycin intravascular chemoembolization (MICE) is a potential treatment for corneal neovascularization (NV) with encouraging early outcomes. We describe a case of focal corneal perforation occurring two years after MICE. A 65-year-old man with a history of penetrating keratoplasty performed 30 years earlier underwent MICE for treatment of corneal NV. Two years later, he presented with acute visual decline in the left eye. At presentation, the visual acuity was 20/200 improving to 20/50 with pinhole in the right eye and counting fingers improving to 20/400 in the left eye. Examination revealed a pinpoint Seidel-positive corneal perforation near the graft-host junction, occurring at the same site previously treated with MICE and adjacent to an area of prior corneal NV and lipid deposition. No trauma, infection, or autoimmune disease was identified. After three attempts of corneal gluing failed, a therapeutic corneal patch graft was performed. Postoperatively, the patient was treated with topical moxifloxacin four times daily and topical prednisolone acetate four times daily. The pinhole visual acuity improved to 20/250 with the pinhole. The anterior chamber remained formed and quiet. Although causality cannot be established, this case raises the possibility of delayed stromal weakening after MICE in a structurally vulnerable cornea and highlights the importance of long-term surveillance following this procedure.
Insights
A rare case of delayed corneal perforation occurred two years after Mitomycin intravascular chemoembolization (MICE) for corneal neovascularization. This highlights the need for long-term monitoring after MICE, especially in vulnerable corneas.
Area of Science:
- Ophthalmology
- Vascular Biology
- Regenerative Medicine
Background:
- Corneal neovascularization (NV) poses a significant threat to vision.
- Mitomycin intravascular chemoembolization (MICE) has emerged as a promising treatment for corneal NV.
- Early outcomes of MICE are encouraging, but long-term complications require investigation.
Purpose of the Study:
- To report a case of delayed corneal perforation following MICE.
- To discuss potential mechanisms and implications of this rare complication.
- To emphasize the importance of long-term surveillance after MICE.
Main Methods:
- A case report of a 65-year-old male patient who underwent MICE for corneal NV.
- Detailed clinical examination, including visual acuity and Seidel test.
- Management of corneal perforation with corneal gluing and therapeutic patch graft.
Main Results:
- A focal, Seidel-positive corneal perforation occurred two years post-MICE near the graft-host junction.
- The perforation site was adjacent to previous corneal NV and lipid deposition.
- Despite failed gluing attempts, a therapeutic patch graft led to improved visual acuity and a stable anterior chamber.
Conclusions:
- This case suggests a potential for delayed stromal weakening after MICE in structurally compromised corneas.
- Long-term surveillance is crucial for patients treated with MICE, particularly those with pre-existing corneal vulnerabilities.
- Further research is needed to establish causality and elucidate the mechanisms of delayed stromal weakening post-MICE.
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