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Management of circumferential mid-peripheral posterior membrane dehiscence causing hydrops in a child with posterior
Mugundhan Rajarajan1, Muralidhar Ramappa2, Sunita Chaurasia3
1Sankara Nethralaya, Chennai, India.
Insights
Blunt trauma in a child with posterior amorphous corneal dystrophy (PACD) caused a posterior membrane defect. Corneal compression sutures effectively treated the resulting edema and vision loss.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Ocular Trauma
Background:
- Posterior amorphous corneal dystrophy (PACD) is a rare genetic disorder affecting corneal clarity.
- Blunt eye trauma can lead to severe complications, including posterior membrane defects.
- Diminished vision and corneal edema are key indicators of significant ocular injury.
Purpose of the Study:
- To report a case of successful management of a posterior membrane defect secondary to blunt trauma in a patient with PACD.
- To evaluate the efficacy of circumferential corneal compression sutures in treating this specific injury.
- To highlight the importance of protective eyewear in preventing such traumatic events.
Main Methods:
- A pediatric patient with PACD experienced blunt trauma, resulting in diminished vision and corneal edema.
- Surgical intervention involved the application of 15 radial corneal compression sutures circumferentially over the posterior membrane defect.
- Serial optical coherence tomography and Scheimpflug imaging were used for documentation and assessment.
Main Results:
- Rapid resolution of corneal edema was observed within 24 hours post-surgery, with visual acuity improving to 20/125.
- Corneal clarity significantly improved over four months, leading to a final visual acuity of 20/40.
- Complete suture removal was performed at the four-month follow-up without complications.
Conclusions:
- Circumferential mid-peripheral posterior membrane dehiscence in PACD can be effectively managed with compression sutures.
- This surgical technique yields favorable visual outcomes and corneal clarity restoration.
- Emphasis on protective eyewear is crucial for managing eyes with PACD and preventing traumatic injuries.
Abstract:
A boy in mid-childhood presented with diminished vision and corneal oedema in the right eye after blunt trauma. Visual acuity was hand motions in the right eye. Slit lamp examination showed diffuse corneal oedema with an area of relative translucency in the mid-peripheral region. The left eye had features characteristic of posterior amorphous corneal dystrophy (PACD). In the right eye, 15 radial corneal compression sutures were applied circumferentially over the posterior membrane defect. Corneal oedema resolved rapidly on postoperative day 1, with visual acuity of 20/125. Corneal clarity continued to improve, and visual acuity was 20/40 at the 4-month follow-up when all the sutures were removed. Serial documentation using optical coherence tomography and Scheimpflug imaging corroborated with clinical features. Circumferential mid-peripheral posterior membrane dehiscence occurring in PACD can be effectively managed with compression sutures to achieve favourable outcomes. Protective eyewear should be included in the management of such eyes.
