DOI: 10.12688/f1000research.188208.1 ISSN: 2046-1402

Case Report: Multimodal ocular imaging of persistent corneal endothelial cell loss following Calotropis gigantea latex induced chemical ocular injury: a 1-year follow-up

Sagar Pandey, Sanjeeta Sitaula, Sauravi Shrestha, Meenu Chaudhary
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Background Calotropis gigantea latex is an uncommon cause of chemical ocular injury that can induce corneal epithelial damage, stromal edema, anterior uveitis, and endothelial dysfunction. Although most reported cases achieve favorable clinical and visual recovery with conservative treatment, objective evidence of persistent endothelial damage using multimodal ocular imaging remains limited. We report a case highlighting the value of anterior segment optical coherence tomography (AS-OCT) and specular microscopy in assessing acute corneal changes and long-term endothelial injury. Case Presentation A 72-year-old woman presented with a 4-day history of painful visual loss, redness, watering, photophobia, and inability to open the right eye after accidental exposure to Calotropis gigantea latex. Examination revealed hand movement vision, elevated intraocular pressure (25 mmHg), a large corneal epithelial defect (7 × 9 mm), diffuse stromal edema, Descemet membrane folds, and 4+ anterior chamber cells with a 0.5-mm hypopyon. Initial microbiological investigations were negative. AS-OCT demonstrated marked corneal thickening (approximately 940 μm) with diffuse stromal hyperreflectivity. Following medical treatment, the epithelial defect healed, inflammation resolved, and best-corrected visual acuity (BCVA) improved to 6/6 within four weeks. However, at one-year follow-up, specular microscopy demonstrated persistent severe endothelial cell loss (648 cells/mm 2 ) with marked polymegathism and pleomorphism despite a clinically clear cornea. Conclusion Calotropis gigantea latex induced chemical ocular injury may result in irreversible endothelial damage despite complete clinical recovery. Multimodal ocular imaging, particularly AS-OCT and specular microscopy, is valuable for documenting acute corneal changes and detecting persistent subclinical endothelial compromise, supporting its role in long-term prognostic assessment.

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