LONG CASE- LEUCOMA

Date of Examination-

PATIENT PARTICULARS-

Name- Mr DEF

Age- 45 years

Sex- Male

Religion- Muslim

Occupation- Farmer

Address-

Socioeconomic Status- Poor economic condition

Chief Complaints-

1) Cannot see clearly with the Left Eye (LE) for 8 months.
2) Whiteness of black portion of the LE for 6 months.

Corneal Leucoma Left Eye

History of Present Illness-

The patient got a vegetable matter foreign body in his LE while working on his farm about 8 months ago.
Two weeks after the injury, he developed dimness of vision with redness, irritability, itching, watering and
intolerance to light in his LE. When the symptoms increased he went for a consultation with the local doctor
who prescribed oral and topical medicines for a left corneal ulcer. Although the other symptoms all
gradually resolved over 2 months, the dimness of vision persisted and gradually the black portion of the LE
turned white. This is when he presented to our hospital for further consultation.

Past Ocular History-

Nil significant.

General Medical History-

Hypertension (HTN) for 1 year and is on treatment.

Drug/ Medicines History-

Amlodipine 5 mg OD for HTN

History of any Allergies especially to Medicines-

Nil known.

Family History-

Nil significant.

Social History-

Not addicted to tobacco or alcohol.

General Physical and Systemic Examination-

Within normal limits (WNL). No anaemia, cyanosis or jaundice found.

Ocular Examination-

Right Eye Left Eye

Visual Acuity (VA) Unaided- 6/6p Unaided- 6/60
Pinhole (PH) No improvement PHNI.
(PHNI).
Eyelids & Eye lashes Position- Normal. Position- Normal.
No blepharitis/ Meibomian Gland No blepharitis/ Meibomian
Disease (MGD)/ entropion/ Gland Disease (MGD)/
ectropion/ trichiasis. entropion/ ectropion/ trichiasis.
Conjunctiva No congestion. No congestion.
Sclera WNL. WNL.
Cornea Clear. Corneal opacity type=
Leucoma. Position- It is almost
completely covering the
pupillary area from the nasal
aspect. Size- 3 mm diameter.
Shape- slightly oval.
Vascularisation- absent.
Anterior Chamber Depth Normal. Normal.
Pupils Pupils equal and react briskly to Pupils equal and react briskly to
light (PEARL). light (PEARL).
Iris Normal colour and pattern. Normal colour and pattern.
No iris adhesion.
Lens Clear. Difficult to see through the
Leucoma.
Purkinje’s Images P1- P4 are all visible. Just P1 is visible.
IOP Normal by digital tonometry. Normal by digital tonometry.
Extraocular muscle movements Full range. Full range.
Lacrimal Apparatus No regurgitation on pressure over No regurgitation on pressure
the lacrimal sac. over the lacrimal sac.
Case Summary-

A 45 year old hypertensive male with reduced vision in the left eye (LE) for 8 months and whiteness of the
black portion of the LE for 6 months. The patient got a vegetable matter foreign body in his LE while
working on his farm about 8 months ago. Two weeks after this, he developed dimness of vision with
redness, irritability, itching, watering and intolerance to light in his LE. When the symptoms increased he
went for a consultation with the local doctor who prescribed oral and topical medicines for a left corneal
ulcer. Although the other symptoms all gradually resolved over 2 months, the dimness of vision persisted
and gradually the black portion of the LE turned white. This is when he presented to our hospital for further
consultation.

On examination, his uncorrected vision in the RE is 6/6p which is not improving with the pinhole. His LE
vision is 6/60 which is not improving with the pinhole.

These findings indicate a likely diagnosis of Leucoma of the left cornea.

Likely Questions-

1) What is a Leucoma?

It is a dense white or opaque scar on the cornea.

2) What does Leucoma mean?

It literally means a white tumour of the cornea (“leucos” means white and “oma” means tumour).

3) How will this patient be managed?

This patient can undergo penetrating keratoplasty or PK.

4) What is a penetrating keratoplasty? What are the indications?

Penetrating Keratoplasty (PK) is full-thickness corneal grafting.

The indications are-

a) Optical, i.e., to improve vision. Important indications are: corneal opacity, bullous keratopathy,
corneal dystrophies and advanced keratoconus.
 b) Therapeutic, i.e., to replace inflamed cornea not responding to conventional therapy.

c) Tectonic graft, i.e., to restore integrity of eyeball e.g. after corneal perforation and in marked
corneal thinning.

d) Cosmetic, i.e., to improve the appearance of the eye.

5) What are the steps of a Penetrating Keratoplasty? (If you are answering very well!)

Surgical technique of penetrating keratoplasty-

a) Excision of donor corneal button. The donor corneal button should be cut 0.25 mm larger than
the recipient, taking care not to damage the endothelium. Donor cornea is placed in a tephlon
block and the button is cut with the help of a trephine from the endothelial side.
b) Excision of recipient corneal button. With the help of a corneal trephine (7.5 mm to 8 mm in
size) a partial thickness incision is made in the host cornea. Then, the anterior chamber is
entered with the help of a razor blade knife and excision is completed using corneo-scleral
scissors.
c) Suturing of corneal graft into the host bed is done with either continuous or interrupted 10–0
nylon sutures.