Intracameral air following pneumatic noncontact tonometry in a recently post–perforating keratoplasty patient
A 42-year-old man had undergone PK for keratoconus in the right eye. A 7.25 mm graft was sutured, with a 10-0 nylon running suture, into the 7.00 mm host bed. The epithelium of the graft was removed at the end of the surgery. The first postoperative day was as usual after PK; the patient had a foreign body sensation, with epiphora and photophobia. Slit lamp examination revealed a transparent graft in niveau, free of epithelium and with Descemet’s striae. The wound was closed, the running suture seemed tight enough, and the anterior chamber was deep and clear. The visual acuity was 0.04 (1.4 logMAR) with no correction. On the second postoperative day, routine tonometry was performed, by the assistant, on the operated eye. The intraocular pressure (IOP) was measured with an NCT (CT-80 Non-Contact Computerized Tonometer; Topcon Corp, Tokyo, Japan); the automatic measurement setting was used, and the measuring range was set in the initial range: 0–30 mmHg. This instrument uses nonsterile air for the measurement. Direct contact with the eye was impossible because the triple safety function of the instrument was in operation. Immediately after the procedure, the patient felt a sharp pain, experienced a deterioration of his visual acuity, and an error signal was indicated on the display. Slit lamp examination revealed that the anterior chamber was well formed, but was two-thirds filled with air. The running suture appeared intact, and no anterior displacement of the wound or anterior wound gap could be observed. A slight stromal haze was noted in the superior part of the graft; the Seidel test was negative. For this reason, we decided on no intervention but simply, close observation of the patient. On the third postoperative day, the air bubble still occupied one-half of the chamber, and the eye remained sensitive. Four days after surgery, the anterior chamber was only one-quarter filled with the air bubble (), and the photophobia had improved considerably. The visual acuity was 0.1 (1.0 logMAR), with no correction. At the 1-week control, the patient was practically free of complaints. His visual acuity was 0.25 (0.6 logMAR), improving to 0.4 (0.4 logMAR) with a +1.0 diopter sphere, and a slit lamp biomicroscopy evaluation revealed a clear cornea with Descemet’s striae, a clear anterior chamber, and a completely healed epithelium. One month postoperatively, the uncorrected distant visual acuity had gained to 1.0 (0.0 logMAR), the corneal astigmatism was 2.5 diopters, and the graft was clear. In the following 1 year, the status of the patient remained practically the same. He was treated with topical antibiotics (levofloxacin 0.5%) for 1 week, and steroid (dexamethasone 0.1%) five times a day in the first week, with the steroid drops (dexamethasone 0.1%) tapering off during the first year.