Sir,
In Turkey, measles epidemics are under control after extensive immunization programmes since the beginning of the 1980 s. However, as Kwan pointed out, we still have older patients who may need cataract operations and there are still patients of all ages in third-world countries. As we share these patients in the modern, borderless Europe, we wish to share our experience also.
Keratitis is present in all patients with measles, however, only one-third of them have ocular symptoms. Measles virus is scattered throughout the whole cornea during the active period of the disease. Exposure also plays a role in the development of peripheral ulcers and adherent leucoma, particularly located at the 6 o'clock position in the presence of xerophthalmia, vitamin A deficiency, and superinfections.1 Anterior segment reconstructions such as pupilloplasty, synechiotomy, and optical iridectomy are necessary during cataract operation.
Penetrating keratoplasty (PK) has a limited role in the treatment of blindness from corneal scarring due to keratomalasia, measles, and vitamin A deficiency.2, 3 In the literature, glaucoma has never been reported in patients who underwent PK due to adherent leucoma caused by measles. According to our clinical experience, intraocular pressure must closely be watched in patients after PK. Secondary damage in the trabecular meshwork and peripheral anterior synechia related with measles may aggravate glaucoma after PK. Penetrating keratoplasty must be applied if the corneal scar in the central axis impedes vision significantly, and patients must be followed closely for glaucoma.
References
Dekkers NWHM . Post measles blindness. Doc Ophthalmol 1983; 56: 137–141.
Yorston D, Wood M, Foster A . Penetrating keratoplasty in Africa: graft survival and visual outcome. Br J Ophthalmol 1996; 80(10): 890–894.
Vajpayee RB, Vanathi M, Tandon R, Sharma N, Titiyal JS . Keratoplasty for keratomalacia in preschool children. Br J Ophthalmol 2003; 87(5): 538–542.
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Koksal, M., Kargi, S. Progression of visual field defect in a normal-tension glaucoma patient after laser in situ keratomileusis. Eye 18, 850 (2004). https://doi.org/10.1038/sj.eye.6701342
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DOI: https://doi.org/10.1038/sj.eye.6701342