%0 Journal Article
%T Sclerokeratoplasty as the Therapy for Corneal Perforation due to Exposure and Neurotrophic Keratopathy
%A Radoslaw Rozycki
%A Izabela Nowak-Gospodarowicz
%A Dominika Bialas
%A Rafal Pawlik
%A Marek Rekas
%J Case Reports in Ophthalmological Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/467249
%X A case report of exposure and neurotrophic keratopathy after acoustic neuroma surgery resulting in perforation if not managed appropriately and timely is presented. Sclerokeratoplasty on 360 degrees may be an effective treatment method of corneal perforation in complete anaesthetic cornea when the standard penetrating keratoplasty failed. At a 12-month follow-up, the patient is doing well. UCVA is 0.5, the IOP is normal, and the graft remains clear. Systemic immunosuppression is the main disadvantage of this method. Further investigation is needed to assess the effectiveness and safety of this method. 1. Introduction Acoustic neuromas (Vestibular Schwannomas) (VS) are oncologically benign tumours which constitute more than 90% of all cerebellopontine angle tumours and more than 10% of all primary brain tumours. Surgical excision of these tumours is one of the most challenging neurosurgical procedures because of their location close to vital structures such as the anterior inferior cerebellar artery (AICA) or the 7th and 8th cranial nerves [1]. When the tumour exceeds 3£¿cm, it might involve the trigeminal nerve causing a depressed corneal reflex, which is accompanied by peripheral facial nerve paresis leading to the development of exposure and neurotrophic keratopathy. This condition, especially with poor Bell¡¯s phenomenon, is usually resistant to conventional therapies and has a very unfavourable prognosis. Loss of the sensory innervation of the cornea decreased the number of corneal stem cells [2], decreased metabolic and mitotic rates in the corneal epithelium, and reduced acetylcholine and choline acetyltransferase concentrations [3, 4] resulting in the development of persistent epitheliopathy. This chronic epithelial breakdown enables proteolytic enzymes to degrade the extracellular matrix components because they cannot protect corneal structural and signaling matrix proteins anymore. This condition may progress to corneal ulceration, perforation, and loss of the eye. The ophthalmic goal of treatment is to protect the cornea from external irritating factors, to stop its progressive degradation, and to support its healing. 2. Case Report The patient was a 64-year-old female with a 4-year history of exposure and neurotrophic keratopathy in the right eye due to unresolved peripheral facial nerve and trigeminal nerve palsies after acoustic neuroma surgery. The patient underwent bilateral cataract surgery at the age of 61 and, except for mild hypertension, remained healthy. After 2 years of satisfactory treatment of lagophthalmos with a gold eyelid
%U http://www.hindawi.com/journals/criopm/2014/467249/