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Unilateral corneal edema caused by a hidden foreign body
Edema corneal unilateral causado por un cuerpo extraño oculto
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Galvis, A. Tello, G.A. Frederick, A.N. Laiton" "autores" => array:4 [ 0 => array:3 [ "nombre" => "V." "apellidos" => "Galvis" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 1 => array:4 [ "nombre" => "A." "apellidos" => "Tello" "email" => array:1 [ 0 => "alejandrotello@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "G.A." "apellidos" => "Frederick" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A.N." "apellidos" => "Laiton" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Escuela de Medicina, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema corneal unilateral causado por un cuerpo extraño oculto" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 838 "Ancho" => 2998 "Tamanyo" => 196752 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A and B) Foreign body in right eye anterior chamber angle, with adjacent anterior synechia. (C) The foreign body was surgically extracted through inferior sclerocorneal incision.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic corneal edema can be caused by a number of conditions, including endothelial dystrophy (Fuchs dystrophy or posterior polymorphic corneal dystrophy); Chandler syndrome, corneal inflammatory diseases (e.g., herpetic endothelitis); surgical or nonsurgical trauma and the toxic effects of a range of substances applied topically (e.g., 4% chlorhexidine and detergent) or systemically (e.g., amantadine).</p><p id="par0010" class="elsevierStylePara elsevierViewall">An intraocular foreign body concealed in the anterior chamber can also be a cause of belated corneal edema, that could lead even to bullous keratopathy which might not develop for months or years after the original lesion.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A patient with unilateral corneal edema was referred to the authors’ practice by the treating ophthalmologist in order to evaluate the possibility of a corneal transplant. The patient had a foreign body in the inferior angle of the right eye anterior chamber which had not been initially detected. The case is reported below.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">Male, 40, treated at another ophthalmological practice due to edema in the lower half of the right eye cornea of unknown etiology, was referred to the authors’ institution. The patient had been treated with steroids and hypertonic saline solution with improvement and worsening episodes of the edema during 2 months.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient denied any history of ocular trauma. Right eye refraction was neutral and far corrected visual acuity was 20/150. Left eye refraction was +0.50 D and far corrected visual acuity was 20/20.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Baseline examination with slit lamp in the right eye found corneal edema with multiple Descemet membrane folds, compromising the visual axis and the adjacent inferior area up to the limbus at 6 o’clock, with images suggesting <span class="elsevierStyleItalic">guttas</span> or pseudo-<span class="elsevierStyleItalic">guttas</span> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Left eye anterior segment examination, including corneal endothelium, was normal. Eye fundus was normal in both eyes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">After anamnesis and baseline clinical examination, gonioscopy was performed in order to discard the presence of any intraocular foreign body hidden in the anterior chamber. A small foreign body was found embedded in the inferior angle at 6 o’clock with adjacent anterior synechia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The patient was asked again about trauma history and he recalled a traffic accident 12 months earlier involving the opening of the vehicle airbag. After another slitlamp examination it was possible to identify a paracentral leukoma that was initially difficult to detect due to the adjacent edema and Descemet membrane folds (white arrows in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The foreign body was surgically removed through an inferior sclerocorneal incision, after which the corneal edema resolved (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The foreign body was made of plastic and had a length of approximately 1<span class="elsevierStyleHsp" style=""></span>mm. Hypertonic saline solution every 3<span class="elsevierStyleHsp" style=""></span>h was indicated initially, subsequently diminished to every 4<span class="elsevierStyleHsp" style=""></span>h, as well as 1% prednisolone every 2<span class="elsevierStyleHsp" style=""></span>h, subsequently diminished and canceled one month later, 0.5% moxifloxacin every 4<span class="elsevierStyleHsp" style=""></span>h during one week. In the first post-surgery days the inferior Seidel test was positive, although one week after surgery it was negative. At that moment, uncorrected visual acuity was 20/60 reaching 20/40 with a refraction of +1.25 D. Slight corneal edema could be observed. Corneal endothelial cell count (SP-3000P<span class="elsevierStyleSup">®</span>, Topcon, Itabashi-ku, Japan) was 702.5<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">2</span> in the central area and 1769<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">2</span> in the superior area.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient did not return for additional follow-up examinations before 2.5 years after surgery. In that last examination, right eye uncorrected visual acuity was 20/40 reaching 20/25 with refraction of +1.00 D. Corneal transparency was good and endothelial cell count was 722<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">2</span>.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Metallic or non-metallic foreign bodies penetrating through the cornea could remain in the anterior chamber.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–10</span></a> Small fragments could be embedded in the angle and remain unnoticed for months or even many years before producing symptoms. Even after these appear, they might not be discovered by the treating ophthalmologist, thus leading to multiple unsuccessful therapies during weeks or months,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> as occurred in the present case. When an asymptomatic foreign body is casually discovered, close follow-up is required giving special attention to the observation of endothelial cell damage. Surgical extraction is indicated in the presence of any inflammation, corneal edema or loss of corneal endothelial cells.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3–5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">After the surgical extraction of the foreign body from the anterior chamber, if the endothelial cell count is not below the critical threshold to maintain normal hydration of the stroma, corneal edema and epithelial microcysts can be resolved.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion, with patients exhibiting unilateral corneal edema of unclear cause, the ophthalmologist should always rule out the presence of intraocular foreign bodies embedded in the anterior chamber. By carefully questioning the patient, the ophthalmologist can increase the suspicion of a foreign body. It must be stressed that, even when the patient denies any trauma history, gonioscopy must be performed in all cases (except in the presence of contraindications) to evaluate anterior chamber angle.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0070" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors in relation to any product or device mentioned in this report.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres888076" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec874018" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres888075" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec874017" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-08" "fechaAceptado" => "2016-06-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec874018" "palabras" => array:5 [ 0 => "Corneal edema" 1 => "Intraocular foreign body" 2 => "Anterior chamber" 3 => "Ocular trauma" 4 => "Bullous keratopathy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec874017" "palabras" => array:5 [ 0 => "Edema corneal" 1 => "Cuerpo extraño intraocular" 2 => "Cámara anterior" 3 => "Trauma ocular" 4 => "Queratopatía bullosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A middle-aged adult male was referred to our institution due to unilateral corneal edema for a possible corneal transplant. At first, the patient denied a history of trauma. A small foreign body, which had been overlooked by the primary ophthalmologist, was detected by gonioscopy, embedded in the anterior chamber angle. It was successfully surgically removed and visual results were good.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In any patient with unilateral unexplained corneal edema, it is necessary to rule out the presence of a foreign body in the anterior chamber.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Un varón adulto de mediana edad fue referido a nuestra institución por presentar edema corneal unilateral para un posible trasplante de córnea. Inicialmente, el paciente negaba una historia de trauma. Un pequeño cuerpo extraño, que había sido pasado por alto por el oftalmólogo tratante inicial, fue detectado por gonioscopía, incrustado en el ángulo de la cámara anterior. Se retiró quirúrgicamente de manera exitosa y los resultados visuales fueron buenos.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En cualquier paciente con edema corneal unilateral sin una causa clara, es necesario descartar la presencia de un cuerpo extraño en la cámara anterior.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Galvis V, Tello A, Frederick GA, Laiton AN. Edema corneal unilateral causado por un cuerpo extraño oculto. Arch Soc Esp Oftalmol. 2017;92:436–438.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0080" class="elsevierStylePara elsevierViewall">The following is the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 998 "Ancho" => 3001 "Tamanyo" => 210577 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Corneal edema in right eye at presentation. A small leukoma (arrows) was very difficult to identify due to adjacent Descemet membrane folds.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 838 "Ancho" => 2998 "Tamanyo" => 196752 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A and B) Foreign body in right eye anterior chamber angle, with adjacent anterior synechia. (C) The foreign body was surgically extracted through inferior sclerocorneal incision.</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 41167157 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-metallic foreign bodies in the anterior chamber" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.B. 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