Korean J Ophthalmol.  2011 Jun;25(3):210-213. 10.3341/kjo.2011.25.3.210.

Neurotrophic Corneal Ulcer Development Following Cataract Surgery with a Limbal Relaxing Incision

• Moon SW
• Yeom DJ
• Chung SH

• KMID: 1010031
• DOI: http://doi.org/10.3341/kjo.2011.25.3.210

Abstract

A 60-year-old man with bilateral corneal opacity underwent cataract extraction surgery involving the use of a limbal relaxing incision in his left eye. He had lower lid ectropion and lagophthalmos in both eyes. Eleven days after the surgery, a slit-lamp examination revealed a neurotrophic corneal ulcer with a punch-out epithelial defect and rolled edges at the center of the pre-existing corneal opacity. The patient was treated with sodium hyaluronate, autologous serum, and oral doxycycline. Six weeks after the surgery an improvement in corneal sensation was observed and the neurotrophic corneal ulcer subsequently healed over the course of one year. In this report, we present a case of neurotrophic keratitis that occurred after performing cataract surgery concurrent with a limbal relaxing incision. As such, we suggest that limbal relaxing incisions should be performed cautiously in patients with causative risk factors for corneal hypesthesia.

Keyword

Cataract operation; Limbal relaxing incisions; Neurotrophic corneal ulcer

MeSH Terms

Cataract Extraction/*adverse effects/*methods
Corneal Diseases/etiology
Corneal Ulcer/*etiology/*pathology/physiopathology
Humans
Hypesthesia/etiology
Limbus Corneae/*surgery
Male
Middle Aged
Ophthalmologic Surgical Procedures/*adverse effects
Phacoemulsification
Wound Healing

Figure

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  Fig. 1 Slit-lamp biomicroscopy on postoperative day 11. Note the punch-out epithelial defect (1.5 × 1.5 mm) with a border of hazy epithelium and stromal edema on the pre-existing corneal opacity, consistent with clinical stage 2 neurotrophic keratitis.

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  Fig. 2 The postoperative change in the mean corneal sensitivity. These data show the sensitivity of the inferior and infero-temporal cornea over the span of the first five months following surgery.

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  Fig. 3 Slit-lamp biomicroscopy at 10 months post-surgery. Note the oval-shaped epithelial thinning (1.5 × 1.5 mm) (A) and some erosion of the pre-existing corneal opacity (B).

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