CIRCUMSCRIBED BULLOUS DEGENERATION OF THE CORNEA DUE TO PERFORATING INJURY WITH SPLINTERS OF GLASS

97th DOG Annual Meeting 1999

P66
CIRCUMSCRIBED BULLOUS DEGENERATION OF THE CORNEA DUE TO PERFORATING INJURY WITH SPLINTERS OF GLASS

H. Agostini, H. Mittelviefhaus

Years after the initial accident a perforating injury with splinters of glass can cause a circumscribed bullous keratopathy, due to a foreign body in the angle. We present two cases with characteristic clinical features.

Patients: In 1987 and 1998, two male patients 47 yrs. and 33 yrs. of age were referred to our hospital with progressive loss of visual acuity due to beginning bullous keratopathy. The changes were unilateral and did not respond to any therapy. At the time of admission visual acuity had dropped to 4/20 and 16/20, respectively. Both patients had suffered penetrating injury of the cornea involving splinters of glass 24 yrs. or 15 yrs. ago, which left only minor scars.

Results: Both patients showed a cloudy appearence of the lower corneal sector. Here, the corneal epithelium was partially detached forming bullae. The corneal endothelial cells in this sector varied in size and shape when compared to the non-affected cornea by Endothelium-Biomicroscopy. In this area, quantitative analysis of the endothelial layer was impaired due to poor optical condition of the cornea. However, gonioscopy revealed splinters of glass in the lower portion of the angle of the anterior chamber. In one case this was confirmed by ultrasonic biomicroscopy. Progression of the bullous keratopathy could be stopped in both cases by removing the foreign bodies. Visual acuity improved from 4/20 to 8/20 and 16/20 to 20/20, respectively.

Conclusions: In case of a partial bullous keratopathy of the lower cornea a preceding perforating injury should be excluded. If a foreign body can be detected in the anterior chamber by gonioscopy it should be removed to avoid progressive damage to the endothelium.

Univ.-Augenklinik Freiburg, Killianstr. 5, D - 79110 Freiburg

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