Contact lens induced bacterial keratitis in LCD II: Management and multimodal imaging: a case report and review of literature

Abstract

Purpose: To describe the management and multimodal imaging of lattice corneal dystrophy type II (LCD-II) complicated by an infectious keratitis due to a bandage contact lens and to review current literature. Observation: A 50-year-old female was diagnosed with Meretoja’s Syndrome by the triad of facial palsy, loose skin (cutix laxa), and stromal corneal dystrophy. At slit lamp, bilateral lattice corneal dystrophy (LCD) was characterized by multiple linear refractile lines and subepithelial fibrosis along with Neurotrophic keratitis Mackie grade I. Findings of anterior segment optical coherence tomography (AS-OCT) were epithelial irregularity, subepithelial fibrosis, hyperreflectivity on anterior stromal layer, lobulated stromal surface. In vivo confocal microscopy (IVCM) showed hyperreflected deposits on the basal and Bowman layers, visible keratocytes; fine lines and streaks between corneal lamella. The sub-basal nerve plexus and the stromal nerves were no longer visible. She presented in emergency with a left red eye. A severe bacterial keratitis was diagnosed as a complication of a bandage contact lens used to treat recurrent epithelial erosion. Corneal anesthesia was complete. Corneal neovascularization was evident 10 weeks later and topical bevacizumab (5 mg/ml) was introduced twice daily. Partial regression of deep stromal vessels was noticed at 3 months. Conclusion: In Meretoja’s syndrome, neurotrophic keratopathy secondary to polyneuropathy due to systemic amyloid deposits is present in the advanced stages, promotes recurrent corneal erosions. Corneal sensitivity test, AS-OCT and IVCM are crucial in the diagnosis behind any recurrent corneal erosion. The use of bandage contact lens should be avoided in Meretoja’s syndrome to prevent a possible infectious keratitis.

Recombinant Human Nerve Growth Factor (Cenegermin)–Driven Corneal Wound Healing Process: An Evidence-Based Analysis

“…This primary ultrastructure could be compromised during the wound healing process, giving way to a progressive swelling and a subsequent corneal opacity, identified as a scar on slit-lamp examination. It means decreased visual acuity in clinical practice, and AS-OCT could detect it as hyper-reflective scar tissue (McCally et al, 2007;Kamma-Lorger et al, 2009;Alafaleq et al, 2021). Type 3 collagen expression is initially significantly improved during the corneal healing process (Cintron et al, 1988).…”

Microbial keratitis in lattice corneal dystrophy: microsporidia as a new cause

“…LCD has been classically known to have two variants: (1) the type-1/classic variant and (2) type-2/associated with systemic amyloidosis, known as the Meretoja syndrome variant. While the latest IC3D classification no longer considers LCD type-2 as a dystrophy because of systemic associations, microbial keratitis has been reported in these patients as well 2 4…”