A 33-year-old female patient came to our centre complaining of decreased visual acuity (VA) in the left eye (LE) for two days, together with pain and photophobia.
The patient had a history of Graves-Basedow disease treated with radioactive iodine and bilateral keratoconus.
With its correction, it has a VA of 0.7 in the right eye (OD) and counts fingers to 20 cm in the left eye.
Intraocular pressure (IOP) is 8 mmHg in both eyes (OA).
A grade 3 keratoconus (Base Classification with DO) is observed in biomycosis, while a moderate degree 4 central corneal scarring is observed in OI, while a degree 4 is observed in OI.
Optical coherence tomography (Visante-OCT) showed Descemet's membrane rupture and secondary tear, corneal edema and the conoid form of the cornea affected.
Symptomatic treatment with 5% sodium chloride and ocular hypotensive agents (Elebloc, 2%, 1 drop every 12 hours) is established.
1.
After one week, observing little evolution of the process, the patient was decided intracamerular SF6.
Technique
In our center we have SF6 in single-dose, at a non-expansive concentration of 20%.
Before injection, the patient should be treated with ofloxacin every 30 minutes for one and a half hours before surgery, and pilocarpine 2%, also instilled every 30 minutes for one and a half hours before surgery.
The preparation of SF6 is performed with an insulin syringe of 1 cc and 40 IU.
0.2 ml were taken through a 0.1 μm Millex-GS® microfilter.
Then a paracentesis is performed with a 15° steel cuchette, the anterior chamber is emptied and the gas is usually injected through a 27-gauge cannula into the anterior chamber volume equivalent to 360-degree space.
The duration of gas in the anterior chamber is usually 4-5 days.
1.
The day after treatment with gas, the patient reported symptomatic improvement and no pain.
A gas bubble is observed at the top of the biomium and the rest are normal.
Treatment with ofloxacin is maintained every 4 hours and the ocular hypotensive agent (Elebloc, 2%) every 12 hours and dexamethasone is added every 4 hours.
Three days later the improvement is already very visible and there is no gas in the pupil area that completely disappears at 6 days.
The patient achieved a VA of 0.05 with refraction and the corneal edema was circumscribed to the inferior temporal side.
Treatment was followed with eye drops and ointment of antiedema with the same pattern as at the beginning.
Two months after surgery, reduction of edema is important and 5% sodium chloride is maintained as the only treatment.
Five months after treatment, the patient remained stable with a single treatment of ointment antiedema at night.
No change or variation in the degree of transparency was observed at the crystalline level.
With a refraction of -10.00 sphere reaches a VA of 0.2.
The patient has now rejected penetrating keratoplasty.
