ArticleJournal of medical case reports2025
Vision rehabilitation of post-Descemet membrane endothelial keratoplasty Pseudomonas keratitis utilizing losartan ophthalmic solution and scleral contact lens: a case report.
Article in Journal of medical case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDescemet membrane endothelial keratoplasty is a preferred treatment for endothelial dysfunction, but complications, such as graft detachment and Pseudomonas keratitis, may affect results. Managing post-keratoplasty infectious keratitis poses unique challenges, with incidence varying by keratoplasty type. Diagnosis typically requires corneal scraping, and treatment strategies encompass broad-spectrum antimicrobials and surgical procedures. CASE PRESENTATION: This current case study examines the treatment of Pseudomonas keratitis in a 76-year-old Jewish male patient following Descemet membrane endothelial keratoplasty, exacerbated by freshwater exposure, in the left eye. Despite initial complications such as graft detachment, a comprehensive treatment plan, including the use of losartan 0.8 mg/mL ophthalmic solution for 7 months, followed by the fitting of a custom scleral toric contact lens, alleviated ocular surface symptoms and quality of vision (by questionnaires). The scleral contact lens provided excellent centration, and the patient's best correction visual acuity enhanced from 0.9 logMAR to 0.2 logMAR, and his near best correction visual acuity improved from Jaeger 13 to Jaeger 3.0 with +2.50 D reading spectacles worn over the scleral contact lens. Additionally, the patient's 10% low-contrast distance best correction visual acuity in the left eye enhanced from 1.3 logMAR to 0.47 (-1) logMAR in photopic conditions when using the scleral contact lens. Patient data were collected after written informed consent.
conclusionsThe present report emphasizes the efficacy of personalized therapeutic strategies in the postoperative management of Descemet membrane endothelial keratoplasty patients, highlighting innovative pharmacological approaches and customized scleral contact lenses in addressing complications and enhancing patient outcomes.
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