Recurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host Disease
Keratoconjunctivitis sicca (KCS) is a common complication of graft-versus-host disease (GVHD), and may lead to corneal epithelial defect and melting. In contrast, recurrent corneal calcareous degeneration and perforation is rare. A 46-year-old woman developed chronic GVHD after bone marrow transplan...
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| Format: | Article |
| Language: | English |
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Elsevier
2006-01-01
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| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S092966460960125X |
| _version_ | 1818264910520385536 |
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| author | Po-Ting Yen Yu-Chih Hou Wei-Chou Lin l-Jong Wang Fung-Rong Hu |
| author_facet | Po-Ting Yen Yu-Chih Hou Wei-Chou Lin l-Jong Wang Fung-Rong Hu |
| author_sort | Po-Ting Yen |
| collection | DOAJ |
| description | Keratoconjunctivitis sicca (KCS) is a common complication of graft-versus-host disease (GVHD), and may lead to corneal epithelial defect and melting. In contrast, recurrent corneal calcareous degeneration and perforation is rare. A 46-year-old woman developed chronic GVHD after bone marrow transplantation for aplastic anemia. Severe KCS with corneal melting and calcium deposits were noted in the left eye. Penetrating keratoplasty was performed because of corneal perforation, but poor re-epithelialization and calcium deposition recurred. Lamellar keratectomy and amniotic membrane transplantation (AMT) were performed, but acute calcareous degeneration developed with subsequent recurrence of corneal perforation. After regraft, AMT and tarsorrhaphy, the corneal graft remained clear for 3 months. However, breakdown of the corneal epithelium occurred 3 weeks after spontaneous separation of tarsorrhaphy. Six months later, corneal perforation recurred again along with exacerbation of GVHD. Regraft was performed, but the patient refused tarsorrhaphy and AMT. Poor re-epithelialization persisted after regraft. Corneal melting with impending corneal perforation ensued. Further corneal surgery was refused and the patient chose to undergo evisceration. This case demonstrates that the ocular complications of GVHD may be severe enough to lead to corneal perforation and calcareous degeneration that is recalcitrant to medical and surgical treatment. |
| first_indexed | 2024-12-12T19:42:25Z |
| format | Article |
| id | doaj.art-eed234deacb14dddb5bacc1058d98d59 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-12T19:42:25Z |
| publishDate | 2006-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-eed234deacb14dddb5bacc1058d98d592022-12-22T00:14:10ZengElsevierJournal of the Formosan Medical Association0929-66462006-01-01105433433910.1016/S0929-6646(09)60125-XRecurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host DiseasePo-Ting Yen0Yu-Chih Hou1Wei-Chou Lin2l-Jong Wang3Fung-Rong Hu4Department of Ophthalmology, Taipei, TaiwanDepartment of Ophthalmology, Taipei, TaiwanDepartment of Pathology, National Taiwan University Hospital, Taipei, TaiwanDepartment of Ophthalmology, Taipei, TaiwanDepartment of Ophthalmology, Taipei, TaiwanKeratoconjunctivitis sicca (KCS) is a common complication of graft-versus-host disease (GVHD), and may lead to corneal epithelial defect and melting. In contrast, recurrent corneal calcareous degeneration and perforation is rare. A 46-year-old woman developed chronic GVHD after bone marrow transplantation for aplastic anemia. Severe KCS with corneal melting and calcium deposits were noted in the left eye. Penetrating keratoplasty was performed because of corneal perforation, but poor re-epithelialization and calcium deposition recurred. Lamellar keratectomy and amniotic membrane transplantation (AMT) were performed, but acute calcareous degeneration developed with subsequent recurrence of corneal perforation. After regraft, AMT and tarsorrhaphy, the corneal graft remained clear for 3 months. However, breakdown of the corneal epithelium occurred 3 weeks after spontaneous separation of tarsorrhaphy. Six months later, corneal perforation recurred again along with exacerbation of GVHD. Regraft was performed, but the patient refused tarsorrhaphy and AMT. Poor re-epithelialization persisted after regraft. Corneal melting with impending corneal perforation ensued. Further corneal surgery was refused and the patient chose to undergo evisceration. This case demonstrates that the ocular complications of GVHD may be severe enough to lead to corneal perforation and calcareous degeneration that is recalcitrant to medical and surgical treatment.http://www.sciencedirect.com/science/article/pii/S092966460960125Xamniotic membrane transplantationcalcareous degenerationgraft-versus-host diseasekeratoconjunctivitis siccatarsorrhaphy |
| spellingShingle | Po-Ting Yen Yu-Chih Hou Wei-Chou Lin l-Jong Wang Fung-Rong Hu Recurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host Disease Journal of the Formosan Medical Association amniotic membrane transplantation calcareous degeneration graft-versus-host disease keratoconjunctivitis sicca tarsorrhaphy |
| title | Recurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host Disease |
| title_full | Recurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host Disease |
| title_fullStr | Recurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host Disease |
| title_full_unstemmed | Recurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host Disease |
| title_short | Recurrent Corneal Perforation and Acute Calcareous Corneal Degeneration in Chronic Graft-Versus-Host Disease |
| title_sort | recurrent corneal perforation and acute calcareous corneal degeneration in chronic graft versus host disease |
| topic | amniotic membrane transplantation calcareous degeneration graft-versus-host disease keratoconjunctivitis sicca tarsorrhaphy |
| url | http://www.sciencedirect.com/science/article/pii/S092966460960125X |
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