Severe Palytoxin Keratitis Rehabilitated With Descemet Membrane Anterior Keratoplasty and Mini-Keratolimbal Allograft After Gundersen Flap for Globe Salvage
Diego Arias, Casey Martin, Albert Y. CheungPurpose:
To describe the globe salvage and visual rehabilitation of a severe case of palytoxin keratitis.
Case Report:
A healthy 42-year-old man developed a corneal ulceration after exposure to palytoxin while working on his aquarium. This was negative for infectious causes by culture and biopsy. After significant keratolysis, there was a perforation necessitating a therapeutic keratoplasty. There was suspected residual toxin present that led to further keratolysis necessitating wound revision, amniotic membrane, and eventually a Gundersen flap with tarsorrhaphy. The eye was allowed to quiet for 3 years. The Gundersen flap was removed over the central cornea, followed by placement of Descemet membrane anterior keratoplasty, mini-keratolimbal allografts, amniotic membrane transplantation, and suture tarsorrhaphy. Cenegermin was also administered. The patient improved from 20/200 preoperatively to 20/30 with a scleral lens after this procedure with 1.75-year follow-up.
Conclusions:
Palytoxin keratitis can lead to devastating sequelae. When necessary, a Gundersen flap can stabilize the eye as a globe salvage procedure. This procedure allowed the eye to quiet, and visual rehabilitation could be pursued at a later date. A combined Descemet membrane anterior keratoplasty and mini-keratolimbal allograft was used to rehabilitate the vision.