Salzmann nodular corneal degeneration (SNCD) is a rare, non-inflammatory, slowly progressive degenerative disease of the cornea. It is characterized by bluish-white nodules raised above the surface of the cornea. SNCD does not seem to consist of one clinical entity, which poses challenges to differentiate it from corneal dystrophies. A 20-year-old Chinese female with a history of eczema and dry eyes presented with a complaint of itchiness in both eyes, watery eyes, and gradual blurring of vision in the right eye for two years. Upon examination, right eye vision was counting fingers, whereas the left eye’s best-corrected vision was 6/9. The anterior segment examination of the right eye showed generalized cornea haziness with superficial vascularization, while the left eye showed mild corneal haziness with no vascularization. Otherwise, both eyes had no signs of corneal infection, corneal scar, subepithelial nodular appearance, or allergic reactions, with no evidence of fluorescein staining. Anterior segment optical coherence tomography (AS-OCT) did not indicate subepithelial opacity. Subsequently, the patient underwent right eye superficial keratectomy under local anesthesia. Although clinically the patient was thought to have a form of subepithelial dystrophy, the histopathological report confirmed it to be SNCD. The best-corrected vision of the right eye improved to 6/12 post-keratectomy. We report an unusual presentation of Salzmann’s corneal degeneration as subepithelial corneal haziness, which was treated successfully with superficial keratectomy.
Interstitial interface keratitis (IIK) in lamellar keratoplasty is a term used to describe infectious keratitis that primarily involves the graft-host interface. It poses specific challenges due to impaired access for microbiological testing and poor penetration of antimicrobial drugs, as well as ease of deeper extension of the microorganism. A 33-year-old male with a medical history of left eye deep anterior lamellar keratoplasty (DALK) with keratoconus, subsequently complicated with steroid-induced glaucoma controlled with Xen tube insertion, presented with acute left eye pain and redness for two days due to one broken corneal graft suture at 5 o'clock position with infiltrate at the graft-host junction. He was treated for suture-related bacterial keratitis (culture-negative) with intensive single broad-spectrum topical antibiotic after suture removal. However, the condition worsened, with dense stromal infiltrate extending into the graft-host interface junction which further progressed to an endothelial plaque. Systemic and topical antifungal treatments were started with adjunctive intracameral and subconjunctival voriconazole before improvement was observed. The condition was resolved with localized scarring without the need for repeat keratoplasty. The best-corrected vision was maintained at 6/36 due to residual sutured-related astigmatism with no signs of corneal graft rejection. Lamellar keratoplasty poses an increased risk of fungal IIK even after several years if there is a predisposing factor e.g., steroid usage and broken suture. Timely diagnosis and intervention are the keys to ensure an optimal outcome.
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