Pseudomonas Keratitis in a Neurotrophic Cornea Ulcer Successfully Treated with Topical Antibiotics, Deep Anterior Lamellar Keratoplasty and Human Amniotic Membrane Transplantation

An 80-years old man came to our attention with severe infection keratitis in his left eye. The patient presented a history of recurrent herpetic keratopathy, leading to severe corneal hypoesthesia and persistent neurotrophic ulceration in affected eye. Slit lamp examination revealed a large paracentral corneal ulcer with stromal melting and hypopyon. Corneal scraping was positive for P. aeruginosa sensitive to ceftazidime. Fortified topical antibiotics led to rapid resolution of the infection. However AS-OCT showed a severe stromal thinning. We performed a no stitch triplelayered human amniotic membrane transplantation (AMT) by using fibrin glue, followed by the application of a scleral contact lens, to reduce inflammation and to prepare the ocular surface for the subsequent deep anterior lamellar keratoplasty (DALK). A few days later, due to persistent corneal thinning, we proceeded with DALK, combined with AMT and with the application of a scleral contact lens. The sequential application of fortified antibiotics, trilaminar AMT, and subsequent DALK and AMT allowed a successful infection control, effective modulation of inflammation, and restoration of corneal structural integrity.