Ranibizumab
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Ranibizumab Neurotrophic keratitis: case report
A 52-year-old woman developed neurotrophic keratitis during treatment with ranibizumab for diabetic macular oedema. The woman was referred by her retina doctors for cornea ulceration and pain 8 days following intravitreal ranibizumab injection [dosage not stated] for diabetic macular oedema. She had been treated with therapeutic soft contact lens, moxifloxacin and erythromycin, which she tolerated for less than 24 hours before the referral. On initial presentation to the clinic, her left eye visual acuity was count fingers. Corneal cultures and smears were obtained. Confocal microscopy revealed only possible double-walled cysts in two images from one sequence. The woman was initiated on fortified tobramycin and vancomycin and chlorhexidine and valaciclovir. The smears and cultures were all negative. Fortified antibiotics were stopped after 2 weeks, and ofloxacin, [polymyxin B] and bacitracin were substituted. Repeat cultures and smears at 3 and 5 weeks and confocal microscopy were negative. At 6 weeks, a diagnosis of acanthamoeba keratitis was ruled out, and chlorhexidine was withdrawn. The ring infiltrate had not changed in appearance and size. At this point, a tentative diagnosis of neurotrophic ulcer (neurotrophic keratitis) was considered. Polymyxin B, bacitracin, lid taping and ofloxacin were maintained, and loteprednol was added. An in-office trial of a therapeutic soft contact lens with parameters and brand different from what was previously used was again intolerable to the patient. Ten days afterwards, the epithelial defect healed with modest symptomatic relief, but a 3 x 4mm recurrence was observed at examination 9 days afterwards. She was then treated with cenegermin, which she tolerated well and resulted in symptom reduction, closing of the epithelial defect and decreased central ring density/opacity. One week following an 8-week course of cenegermin, her vision was 20/400, ring and stromal opacities were reduced and the epithelium remained intact. The epithelium remained intact at subsequent examinations, the most recent occurring 16 weeks following cessation of cenegermin therapy. Alhajraf K, et al. A corneal ring ulcer. American Journal of Ophthalmology Case Reports 20: 100856, Dec 2020. Available from: URL: http://doi.org/10.1016/ j.ajoc.2020.100856
0114-9954/20/1822-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
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Reactions 19 Sep 2020 No. 1822
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