Sterile Corneal Perforation Occurring Several Years After Biliopancreatic Diversion
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Sterile Corneal Perforation Occurring Several Years After Biliopancreatic Diversion Giuseppe Giannaccare 1 & Andrea Lucisano 1 & Marco Pellegrini 2 & Vincenzo Scorcia 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background To report the first two cases of sterile corneal perforation secondary to vitamin A deficiency after biliopancreatic diversion with duodenal switch (BPD/SW). Methods Observational case series. Results Two patients with a history of BPD/SW presented with corneal perforation associated with conjunctival xerosis and keratopathy. In both cases, serum vitamin A level dosage revealed a marked deficit, and the patients admitted poor compliance with vitamin supplementation. Oral therapy with vitamin A was started immediately, and in one case ocular surgery was performed to preserve the integrity of the globe. Conclusions Ophthalmologists should carefully examine the ocular surface of patients undergone bariatric surgery in order to promptly recognize the signs of vitamin A deficiency and avoid serious sight-threatening complications. Keywords Biliopancreatic diversion . Vitamin A . Xerophthalmia . Corneal perforation
Introduction Vitamin A is an essential fat-soluble vitamin that is necessary for ocular surface epithelial integrity as well as for retinal phototransduction. Retinol (preformed vitamin A) is the most active form and is found in animal products, while carotenoids are precursors that are present in vegetables and fruits. In developing countries, vitamin A deficiency represents the leading causes of preventable blindness [1]. Conversely, in developed countries, this deficiency is rare and may occur in the setting of psychiatric eating disorders or malabsorption diseases such as cystic fibrosis, chronic pancreatitis, chronic liver disease, and inflammatory bowel disease [2]. Also patients undergoing bariatric surgery are at risk for vitamin and mineral deficiencies because of decreased intake, change in gastrointestinal anatomy, digestion, rate of transit, and absorption [3]. Vitamin A is mainly absorbed via micelles * Giuseppe Giannaccare [email protected] 1
Department of Ophthalmology, University of “Magna Graecia”, Viale Europa, 88100 Catanzaro, Italy
2
Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
by the mucosa of the proximal jejunum. Relative bile acid deficiency as well as bile acid deconjugation due to upper intestinal bacterial overgrowth is responsible for vitamin A deficiency after bariatric surgery [4]. Low levels of vitamin A were reported in 61–69% of patients after biliopancreatic diversion with duodenal switch (BPD/SW) and in 8–11% after Roux-en-Y gastric bypass (RYGB) [4]. Clinical manifestations of vitamin A deficiency include nyctalopia (night blindness), xerophthalmia, dry skin and hair, and reduced resistance to infections. We report herein the first two cases of sterile corneal perforation occurring several years after bariatric surgery due to seve
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