Supplementary Material for: Therapeutic keratoplasty for large diameter bilateral corneal melts secondary to gonococcal keratoconjunctivitis: A case report

Introduction: Neisseria gonorrhoeae is a common communicable bacterial infection in the U.S. Although primarily affecting the genitourinary tract, ocular involvement—gonococcal keratoconjunctivitis—is a rare but potentially devastating manifestation that can result in corneal melt, perforation, and permanent vision loss. The management of gonococcal keratoconjunctivitis is typically medical, but surgical intervention is warranted in severe cases. Case Presentation: This case details the delayed presentation of a 49-year-old male with gonococcal keratoconjunctivitis leading to bilateral 9 x 10 mm full thickness corneal melts, with unsuccessful corneal gluing prior to transfer. On presentation, examination showed excessive purulence, glue, and disorganized anterior chamber structures, and bilaterally collapsed globes on CT. Vision was at least light perception in both eyes. Given the severity of the disease, the ability to preserve the globes was uncertain, therefore the decision was made to undertake urgent and aggressive medical and surgical intervention with bilateral simultaneous penetrating keratoplasty (PK), which successfully salvaged both globes. At most recent follow-up, the exam showed a visual acuity (VA) of 20/150 with pinhole in the right and a failed graft with light perception in the left. Conclusion: This case demonstrates the potential severity of gonococcal keratoconjunctivitis and highlights the utility of early and aggressive surgical intervention in such cases. Therapeutic keratoplasty along with amniotic membrane provided an effective method of treating gonococcal-associated corneal melt and perforation, allowing for salvage of both globes. While the severity of this case is uncommon, it provides a precedent for the role of therapeutic keratoplasty in similar situations.

引言：淋病奈瑟菌（Neisseria gonorrhoeae）感染是美国常见的传染性细菌感染性疾病。该病虽主要累及泌尿生殖道，但眼部受累——淋球菌性角膜结膜炎（gonococcal keratoconjunctivitis）——是一种罕见但具有毁灭性的临床表现，可引发角膜溶解、穿孔及永久性视力丧失。淋球菌性角膜结膜炎的治疗通常以药物为主，但重症病例需采取手术干预。
病例报告：本病例为1例49岁男性淋球菌性角膜结膜炎迟诊患者，其出现双侧9×10 mm全层角膜溶解，转诊前曾行角膜黏合术但未获成功。就诊时检查可见大量脓性分泌物、黏合剂及前房结构紊乱，CT提示双侧眼球塌陷，双眼视力至少为光感。鉴于病情严重程度，保留眼球的可能性尚不明确，因此决定实施紧急且积极的药物与手术联合治疗，同期行双眼穿透性角膜移植术（penetrating keratoplasty, PK），最终成功挽救双侧眼球。末次随访时，右眼小孔矫正视力为20/150，左眼移植片失败，视力为光感。
结论：本病例展示了淋球菌性角膜结膜炎的潜在严重性，并强调了此类病例早期积极手术干预的临床价值。治疗性角膜移植联合羊膜（amniotic membrane）为淋球菌相关角膜溶解及穿孔提供了有效的治疗方案，可实现眼球挽救。尽管本病例的严重程度较为罕见，但为治疗性角膜移植在类似临床场景中的应用提供了参考依据。