eMedicine Specialties > Ophthalmology > Cornea

Corneal Melt, Postoperative: Follow-up

Author: Arun Verma, MD, Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India
Contributor Information and Disclosures

Updated: Jun 10, 2008

Follow-up

Further Outpatient Care

  • Patients with corneal melts and perforations require close follow-up care. Patients with active melts are followed daily until significant improvement is demonstrated. Patients who have had corneal tissue adhesive for a severe melt of perforation are seen the following day and closely thereafter until improvement is seen.

Deterrence/Prevention

  • Prevention of epithelial damage at the time of cataract surgery and prompt institution of therapy for dry eyes are important to prevent such a devastating complication.
  • Restore ocular surface defense by the following:
    • Discontinuing toxic topical medications
    • Punctal occlusion
    • Application of autologous serum
    • Silicone-based scleral contact lens
    • Plastic reconstruction of lash and lid problem
    • Mucous membrane grafting/amniotic membrane transplantation
      • Facilitates epithelialization
      • Maintains normal epithelial phenotype
      • Reduces stromal inflammation, vascularization, and scarring
      • Allogenic and limbal tissue
    • Avoid epithelial toxic and anesthetic medications.

Complications

  • Complications include infection, bleeding, endophthalmitis, severe visual loss, and blindness.

Prognosis

  • Prognosis depends on the reason for and the extent of the melting. Conditions that are reversible or easily controlled have a better prognosis. Nonperforated melts have better prognosis than perforations.

Miscellaneous

Medicolegal Pitfalls

  • The medicolegal aspects of this problem are not much if the patient is examined thoroughly, proper history is taken, especially predisposing factors, and various treatment modalities and their various possible complications have been precisely and thoroughly explained to the patient. An informed detailed consent from the patient is mandatory.
    • For example, although topical mitomycin-C is effective as an adjunct to pterygium surgery and may reduce recurrence, the safety and efficacy of various concentrations and dosing schedules are not very clear and the patient must be educated about this beforehand.
    • Similarly, beta radiation after surgical removal of pterygia is being used by many surgeons to prevent recurrences, yet it can cause postoperative corneal melting. Thus, the patient must be informed about postoperative corneal melting.
    • More surgeons are performing refractive surgeries, which can lead to very serious postoperative corneal melts in compromised corneas; in these situations, patients must be educated, and an informed consent should be obtained. In the end, if the surgeon is sincere and the patient has faith in the operating surgeon, no medicolegal hassles should occur.
  • Absolute contraindication for photorefractive excimer and LASIK lasers would be patients with rheumatoid diseases because of potential corneal melting ulcers. However, more patients insist on these procedures. They should be properly informed about the potential problems.
  • Progressive postoperative corneal melt has been reported after Nd:YAG or argon therapy, with argon laser trabeculoplasty, transscleral cyclophotocoagulation, with pulsed dye sclerostomy, and with Nd:YAG ab interno laser sclerostomy. It also is very common in those patients receiving 5-FU injections and mitomycin-C along with glaucoma surgery. Therefore, it is imperative that patients are well aware of the possible postoperative complications.
  • Topical medications that are epithelial toxic or are anesthetic should be avoided in eyes with chronic epithelial defects or corneal melts.
 


More on Corneal Melt, Postoperative

Overview: Corneal Melt, Postoperative
Differential Diagnoses & Workup: Corneal Melt, Postoperative
Treatment & Medication: Corneal Melt, Postoperative
Follow-up: Corneal Melt, Postoperative
References
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Further Reading

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Keywords

postoperative corneal melt, corneal melting, corneal perforation, corneal scarring, corneal epithelial defect, corneal tissue, corneal ulcer, corneal ulceration, cornea, vision loss

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Contributor Information and Disclosures

Author

Arun Verma, MD, Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India
Disclosure: Nothing to disclose.

Medical Editor

Richard W Allinson, MD, Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center, Scott and White Clinic
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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