Surgical management of corneal perforation secondary to gonococcal keratoconjunctivitis.
OBJECTIVE
To report five cases of gonococcal keratoconjunctivitis with severe corneal involvement treated with therapeutic keratoplasty.


METHODS
Retrospective case series.


METHODS
Five consecutive cases of gonococcal keratoconjunctivitis treated with keratoplasty for corneal perforation, with a mean age of 21.2 years, were analysed by patient's history, surgical approaches, and clinical outcomes, corrected visual acuity at initial visit and last follow-up.


RESULTS
All adult cases were originally diagnosed as epidemic keratoconjunctivitis by elsewhere, and corneal perforation occurred with a mean duration of 11 days after development of conjunctivitis. While laboratory tests revealed Neisseria gonorrhoeae in all five cases, three patients showed resistance to ofloxacin. Intensive medical treatment using penicillins and/or cephems was initiated. Two patients had peripheral corneal perforations, one had a paracentral perforation, and another, a large corneal perforation with stromal melting. One case had a central microcorneal perforation. In all cases, the anterior chamber was flat. Corneal perforations were treated with lamellar or penetrating keratoplasty using cryopreserved or fresh corneal grafts. All grafts remained clear during the mean follow-up period of 34.9 months. Final best-corrected visual acuity ranged from 20/60 to 20/16.


CONCLUSIONS
Severe gonococcal keratoconjunctivitis can benefit from intensive surgical and medical intervention resulting in satisfactory visual rehabilitation.
Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. motoko-k@sc.itc.keio.ac.jp
M
M
Kawashima
T
T
Kawakita
S
S
Den
M
M
Tomita
J
J
Shimazaki
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D057112:Corneal Perforation / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D003319:Corneal Stroma / Q000473:pathology; D016039:Corneal Transplantation / Q000009:adverse effects / Q000379:methods*; D024881:Drug Resistance, Bacterial; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006069:Gonorrhea / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007637:Keratoconjunctivitis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D009344:Neisseria gonorrhoeae / Q000187:drug effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
D000900:Anti-Bacterial Agents