A Case of Pseudomonas aeruginosa corneal ulcer treated by Penetrating Keratoplasty (PKP) and Descemet's Stripping Automated Endothelial Kertoplasty (DSAEK)

1. Masuo Sakamoto
2. Masahiko Fukuda
3. Keizo Watanabe
4. Shiro Higaki
5. Yoshikazu Shimomura

Department of Ophthalmology,Kinki University Faculty of Medicine,Osakasayama, Japan

Background: Contact lens-related Pseudomonas aeruginosa corneal ulcer often follows a very rapid and serious course. We report a severe case of P. aeruginosa corneal ulcer which was given Penetrating Keratoplasty (PKP) and Descemet's Stripping Automated Endothelial Kertoplasty (DSAEK).

Case: The subject was 28-year-old male who developed P. aeruginosa corneal ulcer and the visual acuity of the left eye dropped to hand movement. He was hospitalized and given antibiotics locally and systemically, however, the cornea melted widely with an imminent risk of perforation. Therefore, PKP was performed in the same month with an 8-mm trephine. Postoperative visual acuity once reached to 0.1, however, rejection occurred after 2 months and graft failure occurred although steroid therapy was carried out. The patient strongly wished to restore the visual acuity. Therefore, in November 2009 a second keratoplasty was given by DSAEK. Transparency of the cornea was restored for a time and the visual acuity of 0.1 was achieved, however, 3 weeks after the surgery, rejection occurred and the graft failed again.

Conclusion: Various factors can be attributed to this poor prognosis: the case had a widespread lesion of P. aeruginosa corneal ulcer; neovascularization was active when we had to perform the first PKP; the first graft was large; and the case was young.