Bilateral corneal ulceration in ocular graft-versus-host disease
A 28-year-old woman presented complaining of dryness, irritation, photophobia, and a “gush” of fluid from her right (first) eye that occurred 5 days before she presented to our clinic. The patient’s past medical history was significant for herpes simplex virus keratitis in her right eye, AML treated with allogeneic HSCT, and ocular GVHD. At presentation, ocular examination revealed an inferocentral corneal perforation plugged with iris tissue in the patient’s right (first) eye. Given that the anterior chamber was quiet, deep, and intact, surgery was deferred and aggressive broad-spectrum antimicrobial therapy with lubrication was initiated. The corneal perforation eventually healed, leaving behind a small scar with an adherent leukoma. The patient subsequently underwent cataract surgery in her left eye; the postoperative course was uneventful until 1 month after surgery, when she returned with pain, redness, and decreased vision. Ocular examination revealed a 2.0 × 1.2 mm inferocentral area of stromal thinning with underlying infiltrate and a <1.0 mm2 superocentral area of stromal thinning in the patient’s left (second) eye. The patient was treated with broad-spectrum antimicrobial therapy and aggressive lubrication, after which the ulcers healed with some residual thinning and scarring. At the patient’s last follow-up visit, her BCVA was 20/30 in her right eye and 20/30 in her left eye.