Acute corneal melting one week after an uncomplicated cataract surgery in a patient who previously underwent eyelid radiation and with undiagnosed rheumatoid arthritis: a case report

ABSTRACT This is a rare case report of acute, paracentral corneal melting and perforation occurring 1 week after an uneventful cataract surgery, with discussions on possible pathogenetic mechanisms. Relevant literature was also reviewed. Herein, a case of an 86-year-old woman with acute, paracentral, and sterile corneal melting and perforation in her left eye at 1 week after an uncomplicated cataract extraction is described. This occurs at the base of ocular surface disorders due to previous radiation of her lower eyelid and cheeks for the treatment of cancer and previously undiagnosed rheumatoid arthritis. She underwent surgical treatment using Gundersen’s conjunctival flap for the existing perforation due to low visual expectancies and reluctance to undergo corneal keratoplasty due to the risk of corneal graft rejection. The risk of coming across an acute corneal melting after an uncomplicated cataract surgery in the eyes with ocular surface disorders should always be considered.摘要 本报告为罕见病例，记录1例于无并发症白内障手术后1周发生急性旁中心性角膜融解并穿孔的案例，并探讨其可能的发病机制，同时复习了相关文献。本文报告1例86岁女性患者，其左眼在无并发症白内障摘除术后1周出现急性旁中心性无菌性角膜融解并穿孔。该病例的发病基础为眼表疾病，诱因包括既往因癌症治疗接受下眼睑及面颊部放射治疗，以及此前未被诊断的类风湿关节炎。因患者视力预后不佳，且因担心角膜移植排斥反应风险而拒绝行角膜移植术，故针对已发生的穿孔采用冈德森结膜瓣（Gundersen conjunctival flap）进行手术治疗。对于存在眼表疾病的患者，在无并发症白内障手术后需始终警惕急性角膜融解的发生风险。