Progressive aseptic melting of the corneal graft in patient with concomitant blood leukemia and repeated chemotherapy

Purpose. To present the clinical features and evaluate the effectiveness of treatment for a patient with progressive aseptic melting with concomitant leukemia and repeated chemotherapy. Material and methods. Patient L. was examined with progressive aseptic melting of the corneal graft, he has a concomitant blood leukemia and had a history of repeated chemotherapy. The patient underwent the following surgical interventions: anterior lamellar keratoplasty, and then penetrating keratoplasty. In the postoperative period of the second intervention, a scleral contact lens (SCL) was used in combination with tear replacement therapy. Results. Complete epithelization of the stromal defect of the corneal transplant and improvement of visual functions were achieved. Conclusion. The toxic effects of systemic chemotherapy for leukemia can lead to various corneal complications, so clinicians should be aware of possible vision threatening complications and know how to treat them. Invasive methods to prevent the progression of aseptic corneal melting with the threat of perforation include biological amnion coverage or blepharorrhaphy. An alternative treatment option that avoids unnecessary surgical trauma is the use of SCL. One of the contraindications to the use of SCL is the presence of sutures on the cornea. But comparing the risks of suture dehiscence under the influence of negative pressure under a scleral lens with the risk of aseptic melting of the graft gives grounds to prescribe scleral contactlenses for this category of patients. Scleral contact lenses, used to maintain hydration of the ocular surface and as a fluid reservoir, are a therapeutic system that allows us to solve the problem of progressive aseptic melting of the corneal graft, when conventional contact lenses and drug treatment have not led to a positive effect, and surgical intervention is undesirable or contraindicated.