MANAGEMENT DILEMMA OF TREATING AN AIDS PATIENT WITH RECURRENT CORNEAL EROSION (RCE) SECONDARY TO LATTICE DYSTROPHY

Connie Chronister

Abstract

BACKGROUND: We present the first case reported in the literature of an AIDS patient with RCE secondary to lattice dystrophy. Management of a healthy patient with recurrent corneal erosions from lattice dystrophy can be clinically challenging. An immunocompromised AIDS patient may further complicate the course of therapy.

CASE REPORT(S). A 49-year-old male presented with a chief complaint of difficulty opening his eyes in the morning, tearing, photophobia and discharge OS X 1 day. His ocular history is significant for lattice corneal dystrophy OU, recurrent corneal erosion OS, and herpes simplex keratitis OS. Systemic history was remarkable for Hepatitis C and HIV (AIDS) with secondary pneumocystis carinii pneumonia. Viral load was 35533 copies/ml and CD4 count was 99 cells/mm3. Best-corrected visual acuities were OD 20/80, OS 20/50. Slit lamp exam revealed severe lattice corneal dystrophy OU, with a 1.5 X 1.5-mm abrasion OS. Anterior chamber was without cells or flare. The patient was prescribed bacitracin/polymyxin B ung qid OS. He was followed on a daily basis and was re-epithelialized after 3 days of treatment.

CONCLUSIONS. Management of lattice dystrophy with secondary RCE in an AIDS patient requires that the clinician be familiar with the patient’s immune status because as the CD4 count declines and the viral load increases, this indicates an increased potential for opportunistic anterior segment infections. The clinician should monitor that patient closely for potential complicating ocular sequelae of AIDS such as: herpes zoster ophthalmicus, herpes simplex keratitis, fungal/bacterial keratitis, keratoconjunctivitis sicca and Kaposi’s sarcoma. In managing our patient, we chose topical antibiotic ointment, which had the least potential for complications and monitored the patient daily for opportunistic infections. The more invasive management of RCE such as diamond burr polishing and epithelial basement membranectomy, anterior stromal puncture, and phototherapeutic keratectomy should be utilized judiciously in an immunocompromised patient. We will review lattice dystrophy, RCE and approaches to the management of RCE in an AIDS patient.

Details

Year: 2001

Program Number: Poster 63

Author Affiliation: Pennsylvania College of Optometry

Co-Authors: Michele Wasilauski

Co-Author Affiliation: Pennsylvania College of Optometry

Room: Exhibit Hall C