Scleral perforation following diode laser trans-scleral cyclophotocoagulation

Abstract

microsporidia spores, which were confirmed by 1% acid-fast stain. Polymerase chain reaction (PCR) for microsporidia was performed using primers capable of identifying several Enterocytozoon and Encephalitozoon species of microsporidia. 3 A single B270 base pair fragment was observed on agarose gel electrophoresis and ethidium bromide staining of the PCR amplified patient sample (Figure 2b). Topical steroids were discontinued and he was treated with topical 0.3% ciprofloxacin eight times daily along with topical lubricants. After 10 days, all his lesions had disappeared (Figure 1b). The patient was seronegative for HIV by ELISA test.Bilateral punctate epithelial keratopathy and conjunctivitis has been described in immunocompromised 1,2 and more recently in immunocompetent patients as well. 4,5 Previously described risk factors like trauma, contact lens wear, prior refractive surgery or exposure to contaminated water were absent in our patient. The only possible associated risk in this case was the use of topical steroids, leading to a localized immunosuppressed state, resulting in secondary infection by microsporidia. In our patient, diagnostic debridement probably debulked the epithelium of the load of organisms and hastened resolution. Contrary to belief that debridement worsens the infection by driving the organisms into the stroma; we found that debridement actually hastens resolution. 2 CommentTo the best of our knowledge, this is the first report of keratoconjunctivitis caused by microsporidia in a corneal graft. As a result of local immunosuppression, this infection can occur in patients who have been grafted, which has not previously been described. The differential diagnosis of microsporidial keratitis should be considered in this subset of patients presenting with typical features of multiple epithelial lesions in the cornea.

Transscleral cyclophotocoagulation in refractory acute and chronic angle closure glaucoma

“…It has been associated with postoperative iritis, hypotony, scleral thinning or perforation,13 necrotising scleritis,14 corneal oedema, conjunctival burns, pain or raised IOP. Increasing experience worldwide with TSCP has optimised laser settings to reduce the incidence of adverse outcomes, with numerous series reporting lack of complications 11.…”

Incidence of hypotony and sympathetic ophthalmia following trans‐scleral cyclophotocoagulation for glaucoma and a report of risk factors

“…Four cases of sympathetic ophthalmia have been reported following TSCPC . In the extended literature search conducted, we identified 5979 eyes (6049 eyes including the current study) that had undergone diode laser TSCPC . If we include all cases of diode laser TSCPC reported in the literature (including the current study), the incidence is estimated at one in 1512, or 0.07% (95% CI 0.03%–0.17%).…”

An update on continuous‐wave cyclophotocoagulation (CW‐CPC) and micropulse transscleral laser treatment (MP‐TLT) for adult and paediatric refractory glaucoma

“…In addition, a very thin sclera may be a contraindication to TSCPC. There is thus an increased risk of overdose (reduction in scleral absorption and diffusion phenomena) and scleral thinning which can ultimately result in perforation despite the currently marketed G‐probe (Sabri & Vernon, 1991; Kwong et al 2006). To limit complications, the delivered energy is lower than in adults (Table 4).…”