Letter to the Editor
Anterior segment optical coherence tomography in a case of penetrating corneal necrosis repair with amniotic membrane
Tomografía de coherencia óptica de segmento anterior en reparación de necrosis corneal penetrante con membrana amniótica
R. Montejano-Milnera,b,c,
, J.V. Dabad-Morenod, A. de la Hoz-Poloe,f,c, A. Boto de los Bueisd,g
Corresponding author
a Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
b Clínica Novovisión, Madrid, Spain
c Universidad CEU-San Pablo, Madrid, Spain
d Hospital Universitario La Paz, Madrid, Spain
e Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
f Miranza IOA, Madrid, Spain
g Clínica Baviera, Madrid, Spain
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"apellidos" => "Boto de los Bueis" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Clínica Novovisión, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Universidad CEU-San Pablo, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Miranza IOA, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Clínica Baviera, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tomografía de coherencia óptica de segmento anterior en reparación de necrosis corneal penetrante con membrana amniótica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1523 "Ancho" => 2007 "Tamanyo" => 364643 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Surgical microscopic view of the eyeball immediately prior to repair. Note the 4 × 2 mm full-thickness inferior paracentral stromal necrotic tissue. B) Intraoperative microscopic view of the multilayered amniotic membrane (AM) patch sutured to the corneal stroma adjacent to the defect with 10-0 nylon loose stitches. C) Early postoperative anterior segment optical coherence tomography view of full-thickness defect repair using multilayer patch and AM graft with therapeutic contact lens.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the clinical case of Drs Sánchez Sanz and Azorín Pérez, accepted for publication in this journal,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on the role of anterior segment optical coherence tomography (AS-OCT) in determining whether clinically striking stromal thinning implies Descemet's membrane involvement and, therefore, the presence of a penetrating ocular injury. We agree with the authors on the essential role of this non-invasive diagnostic technique in clarifying doubtful cases such as the one they present and illustrate, as well as in directing the therapeutic management of the case.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this regard, we would like to share a clinical case which exhibited penetrating corneal necrosis. The patient was a 75-year-old man with erosive rheumatoid arthritis under follow-up in corneal consultations, whose cataract surgery had been delayed due to herpetic stromal keratitis in the left eye (LE). She attended the emergency department for pain in the LE, presenting with 90% central corneal thinning of 4 × 2 mm, compatible with necrotising stromal keratitis. At 24 h, the presence of Seidel was observed, and urgent reconstructive surgery was proposed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On the same day, under general anesthesia, debridement of necrotic tissue (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), suture of multilayered patch of amniotic membrane (AM) with loose stitches of 10-0 nylon (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), anterior chamber formation, Seidel's negativisation check, MA graft sutured to limbus with 7-0 Vicryl, placement of therapeutic contact lens (TCL), antibiotic prophylaxis and ocular occlusion were performed on the LE.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">On examination the following day, the absence of Seidel's and good coverage of the defect by the AM was observed. An AS-OCT was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), which showed: a hyper-reflective surface structure, corresponding to the AM patch; a hyper-reflective membrane extending superficially and peripherally to the anterior structure, corresponding to the AM graft; a hyper-reflective and convex structure, corresponding to the TCL; and total and progressive thinning of the edges of the penetrating corneal wound, as a result of the process of stromal necrosis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The role of AS-OCT has been documented by several authors in traumatic corneal disease<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> to determine the depth of foreign bodies impacted in the corneal thickness,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> as well as to monitor the evolution of microbial<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> or herpetic keratitis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Likewise, it has been used intraoperatively<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> or in the subsequent outpatient follow-up<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> to determine the coverage of partial or full thickness defects in the cornea. In the case we report, AS-OCT allowed immediate postoperative observation of the correct coverage of the full-thickness defect with the MA patch.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Over time, the speed of acquisition, the repeatability of the scans, as well as the ease of capture for the patient and the explorer, have made AS-OCT a key tool in the management of corneal diseases that compromise the integrity of the eyeball and require urgent medical or surgical management.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">This work has not received any funding for its conception, development or publication.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1523 "Ancho" => 2007 "Tamanyo" => 364643 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Surgical microscopic view of the eyeball immediately prior to repair. Note the 4 × 2 mm full-thickness inferior paracentral stromal necrotic tissue. B) Intraoperative microscopic view of the multilayered amniotic membrane (AM) patch sutured to the corneal stroma adjacent to the defect with 10-0 nylon loose stitches. C) Early postoperative anterior segment optical coherence tomography view of full-thickness defect repair using multilayer patch and AM graft with therapeutic contact lens.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Perforación o no? La tomografía de coherencia óptica de segmento anterior como clave diagnóstica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Sánchez Sanz" 1 => "L. 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