case_images: PMC7667595_01
case_images: Ocular surface findings in a 24-year-old woman with descemetocele following acoustic neuroma surgery. Slit-lamp examination showing images of the left eye presenting severe NK with a large paracentral descemetocele (top left) that was treated in emergency with a multilayer AMT. Three months after surgery the patient presented with a dense corneal leucoma (top right) requiring an optic PK (bottom left). Two weeks after PK a NK recurrence was observed (bottom right) with a central oval ulcer and a peripheral thinning on the suture. Treatment with cenegermin was initiated.
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case_images: PMC7667595_01_IMCRJ-13-617-g0001.jpg
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case_images: The patient came to our attention with a large paracentral oval descemetocele in the left eye, diagnosed as stage 3 NK, that required multilayer amniotic membrane transplantation (AMT) (Figure 1). The subsequent onset of peripheral melting required to remove the running suture and replace it with an interrupted suture (Figure 1).
case_images: Ocular surface findings following cenegermin treatment for NK on PK. Slit-lamp examination showing full closure of the corneal ulcer after rh-NGF treatment with some residual stromal scarring (top left). One week after treatment discontinuation a second NK recurrence was observed (top right), that required a repeated AMT and PK approach. A second course of cenegermin was then initiated in the immediate postoperative days to prevent further NK recurrences. The treatment cycle was successfully completed as the patient presented with an intact epithelium and a transparent graft at the end of treatment (bottom left) and at the 12-months follow-up visit (bottom right).
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case_images: PMC7667595_01_IMCRJ-13-617-g0002.jpg
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case_images: However, one week after the end of treatment, a recurrence of NK was observed (Figure 2), which was first managed by AMT surgery and later by a tectonic PK due to the persistence of stromal melting.. The patient was managed with preservative-free artificial tears in the follow-up (hyaluronic acid 0.2% 6 times a day) and presented at the last visit (12 months after the end of Oxervate treatment) with a stable ocular surface and a BCVA of 20/40 (Figure 2).