Surgical treatment of purulent corneal ulcers in eyes with neurotrophic keratitis and paralytic lagophthalmos

Abstract

Patients with intracranial lesions complicated by neurotrophic keratitis and lagophthalmos often develop progressive purulent ulcers of the cornea. One-step keratoplasty, autoconjunctivoplasty, and permanent partial tarsorrhaphy is an effective treatment that can help preserve visual function in such eyes.

Multi-Disciplinary Approach in a Case of Neurotrophic Keratitis with Vestibular Schwannoma and Seventh Cranial Nerve Palsy

“…Cornea healed with improved visual acuity to 6/36 as seen in subsequent follow up visits. As experienced by Kasparova EA et al in their study of 12 patients (13 eyes) with intracranial lesions complicated by neurotrophic keratitis and lagophthalmos receiving permanent partial tarsorrhaphy as a part of combined surgery that included simultaneous keratoplasty, autoconjunctivoplasty, also proposed to be an effective treatment that can help preserve visual function in such eyes 8 .…”

Untitled

“…Wounds in pressure | ulcers are chronic and immune to the normal iterative healing process, thanks to the presence of high bioburden [28]. In the pressure wound metabolic environment, there exists a dominant presence of Firmicutes, Proteobacteria, and Actinobacteria [13]. The colonization of the wound by these multiple pathogens, however, differs from one sore to another [29].…”

“…The wound healing process depends on the individual's body's response [23]. Immuno-suppressed patients have increased risk for hypothermia, thus affecting the postoperative wound healing process and increase the risk of infection [13]. Diabetic patients have high levels of blood glucose that affect the nerves leading to poor blood circulation thus less blood needed for skin repair or to reach the affected areas [16].…”

“…The feedback received showed that rigorous assessments are crucial before issuing treatment protocols to pressure ulcer patients [13]. The testing should be able to force the causative agent to be removed before implementing management plans such as improved nutrition [2].…”

“…Dressing of the sacral wounds was done using single or double gluteus maximum flaps [12]. Those with ischial ulcers were covered with either biceps femoris or gluteus maximum hatchet flaps [13]. Questionnaires with instructions and contact details were issued to the patients for assessment of the surgical treatment received [14].…”