Readers, if you are thinking of cataract surgery, please read the story. A 69 year old lady complains reduced vision after 2 years of the cataract surgery. Initially, she was sent to the retinal evaluation, but after all the necessary treatment, her condition did not improve. She was sent for a neuro-ophthalmic exam to try to determine the etiology of the decreased vision followed by an MRI. She was diagnosed with mild cystoid macular edema 2 weeks before her return visit, and she was given topical nepafenac drops four times a day in the right eye. Her BCVA can count fingers in the right eye and 20/25 in the left (pinhole to 20/20). Pupils in the effected eye was slightly less interactive.
The key to this case was that the patient was on a topical nonsteroidal anti-inflammatory drop for chronic cystoid Macular Edema. This patient was cultured for bacterial, viral and fungal causes of the melt to rule out an infectious etiology, which was thought not to be likely, and the patient was diagnosed with a corneal melt secondary to chronic topical NSAID use. The patient was placed on ciprofloxacin ointment and oral doxycycline.
The patient showed rapid resolution of the epithelial defects with no further melting. All cultures showed no growth after a period of 3 weeks. At her most recent visit, the patient had two corneal scars with slight thinning at the sites of the erosions. She was fit for a hard contact lens in the right eye with a slight improvement in her vision. She continues to be evaluated by the neuro-ophthalmology service for the underlying cause of her decreased vision.
Source: OSN Super Site