![]() Examination revealed an inferior rupture of Descemet’s membrane and a perforation at the 7 to 8 o’clock position with a brisk leak. The patient presented again 2 years after the original perforation with very similar symptoms in her fellow eye. At 9 weeks after initial presentation the perforation healed with no leakage and a small residual epithelial deficit ( Fig. Corneal status was monitored with SS-ASOCT ( Fig. She was reviewed on a weekly basis for 7 weeks and during this period required two further gluing procedures. Due to the risk of infection, the patient had corneal cyanoacrylate glue applied with subsequent bandaging. Topical steroids were added to her current regime and she was reviewed after 72 h.Īt this time point the patient had a relatively well-formed anterior chamber, but there was ongoing leakage from the site of perforation. A review 24 h later showed a more formed anterior chamber, no iridocorneal touch and reduced rate of aqueous leakage. In addition, she was given oral ciprofloxacin, topical levofloxacin and atropine. In view of a relatively well-formed anterior chamber, absent lenticular corneal touch and low flow leakage, the leak was managed with a bandage contact lens was (PureVision2™, Bausch & Lomb, USA). ![]() Peripheral thinning is also demonstrated in these images consistent with the diagnosis of PMD. Seven-week follow-up SS-ASOCT images showing partial resolution of the corneal perforation in the posterior stroma with remaining disorganization anteriorly. In the absence of systemic features, normal blood tests and contralateral thinning an underlying systemic disease was felt to be unlikely. Blood was obtained to screen for potential systemic disorders associated with corneal perforation (full blood count, urea and electrolytes, erythrocyte sedimentation rate, C-reactive protein, full vasculitic and syphilis screen). Pentacam ® (Oculus) topography of the contralateral cornea showed evidence of peripheral steepening and thinning consistent with a diagnosis of PMD ( Fig. The patient was investigated with SS-ASOCT (DRI OCT Triton, Japan) that confirmed the presence of a corneal perforation, iridocorneal touch and an iris strand extending to the perforation ( Fig. SS-ASOCT image revealed the presence of an oblique corneal perforation and localized corneal edema ( C, D) as well as iridocorneal touch near the site of perforation (D). Inferiotemporal peripheral cornea with a bandage contact lens in situ ( A) and associated localized edema ( B). Examination of the contralateral eye revealed evidence of inferior corneal thinning. On administration of 2% fluorescein there was a positive Seidel’s test that highlighted low flow leakage of aqueous ( Fig. There was associated iridocorneal touch, shallow anterior chamber and iris stranding to the site of rupture. Assessment of the right eye showed an inferior rupture of Descemet’s membrane and a perforation at the 7 o’clock position. On examination, pinhole visual acuity was 0.6LogMAR and 0.1LogMAR in the right and left eye, respectively. There was no past medical or ocular history of note. There was no history of trauma, allergy, contact lens use or potential exposure to infection. The patient, a 47-year-old Somali woman, presented with a 3-day history of right-sided sharp ocular pain, clear discharge, redness and foreign body sensation. To the best of our knowledge, the incidence of perforation in PMD is not reported in the literature, but one large case series of 116 eyes has reported an incidence of hydrops of 6%. We present a case in which swept-source anterior segment ocular coherence tomography (SS-ASOCT) was used to contribute to the diagnosis and aid in determining the therapeutic management of a patient with spontaneous corneal perforation secondary to pellucid marginal degeneration (PMD). Alongside the clinical evaluation, it can be used to monitor the clinical response. SS-ASOCT is a useful adjunctive tool in the clinical assessment and evaluation of spontaneous corneal perforation. The patient was managed with a combination of contact bandaging and corneal gluing. ASOCT images revealed full-thickness perforation, iridocorneal touch and iris stranding. Corneal topography demonstrated peripheral thinning and steepening in the contralateral eye. Clinically she had a corneal perforation at the inferior cornea with associated loss of anterior chamber volume. We describe a case of bilateral spontaneous corneal perforation secondary to pellucid marginal degeneration and present the associated swept-source anterior segment optical coherence tomography (SS-ASOCT) findings and management principles used.Ī 47-year-old woman presented with ocular pain, redness, foreign body sensation and clear discharge in the right eye in 2017 and with very similar symptoms in 2019 in the left eye.
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