A 25-year-old man visited our hospital with ocular pain on the left eye, showing corneal shield ulcer and atopic conjunctivitis. Eye drops of 0.1% of betamethasone sodium phosphate and 0.1% of hyaluronic acid ophthalmic solution were prescribed, but his ocular pain and corneal findings persisted. The corrected visual acuity was 6/20 in Snellen chart at the first visit. At 40 days after the beginning of treatment, calcific corneal opacities developed in the corneal epithelium. Six months after the first visit, the corrected visual acuity decreased to 4/20, and keratectomy was planned to remove calcification in the cornea ().
Slitlamp microscopic image of a 25-year-old man showing corneal shield ulcer at 40 days after beginning of treatment. After diminishing atopic conjunctivitis and corneal shield ulcer, calcific corneal opacities developed under the corneal epithelium.
The operative procedure included corneal epithelial exfoliation over almost the entire cornea using a golf club spud, followed by removal of corneal opacity using MQA (MQA eco-stick, Inami, Tokyo, Japan) soaked in 0.05
M of ethylenediaminetetraacetic acid (EDTA) (Sigma-Aldrich, St. Louis, MO, USA) [6
]. After washing the eye with 200
mL of physiological saline, a silicon hydrogel lens, PureVisionTM (balafilcon A) (Bausch & Lomb, Rochester, NY, U.S.), was inserted to obtain pain relief for the therapeutic use. We have got obtain permission by ethics committee of our hospital for this procedure. Postoperative medication included instillation of levofloxacin ophthalmic solution, 0.1% fluorometholone ophthalmic solution, and 0.1% hyaluronic acid ophthalmic solution 4 times a day for 2 weeks. Ofloxacin eye ointment was applied twice daily for only 4 days. At the end of the surgery, a silicone hydrogel lens was inserted continuously for 1 week to reduce ocular pain.
At postoperative day 11, wearing second lens after post-operative day 7, mucin balls were found between cornea and contact lens and were stained with rose bengal eye solution. One of them was atypically larger than usual size, which could vary between about 20 and 200μ
m. In the present case, the major axis was approximately 1.5
mm (). At the same time, as corneal erosion was diminished, wearing silicone hydrogel lens was stopped and instillation of every eye drop was continued until the disappearing of all the corneal staining. One week later (at post-operative day 18), all of mucin balls and corneal staining were disappeared and the corrected visual acuity increased to 6/20. Little corneal opacity remained, and visual acuity after surgery recovered to 14/20 at five months (). There was no change between preoperative corneal endothelial cell density (2797.5 ± 100.8
) and postoperative (2840.6 ± 123.1
Atypically larger mucin balls found at post-operative day 11 wearing silicone hydrogel lens. They were stained with rose bengal dye (arrows).
Corneal image at the final visit at 5 months after surgery. Little opacity was found in the cornea.