Therapeutic Keratoplasty for Large Diameter Bilateral Corneal Melts Secondary to Gonococcal Keratoconjunctivitis: A Case Report.

INTRODUCTION: Neisseria gonorrhoeae is a common communicable bacterial infection in the USA. Although primarily affecting the genitourinary tract, ocular involvement - gonococcal keratoconjunctivitis - is a rare but potentially devastating manifestation that can result in corneal melt, perforation, and permanent vision loss. The management of gonococcal keratoconjunctivitis is typically medical, but surgical intervention is warranted in severe cases.

CASE PRESENTATION: This case details the delayed presentation of a 49-year-old male with gonococcal keratoconjunctivitis leading to bilateral 9 × 10 mm full-thickness corneal melts, with unsuccessful corneal gluing prior to transfer. On presentation, examination showed excessive purulence, glue, disorganized anterior chamber structures, and bilaterally collapsed globes on CT. Vision was at least light perception in both eyes. Given the severity of the disease, the ability to preserve the globes was uncertain; therefore, the decision was made to undertake urgent and aggressive medical and surgical intervention with bilateral simultaneous penetrating keratoplasty, which successfully salvaged both globes. At the most recent follow-up, the exam showed a visual acuity of 20/150 with pinhole in the right and a failed graft with light perception in the left.

CONCLUSION: This case demonstrates the potential severity of gonococcal keratoconjunctivitis and highlights the utility of early and aggressive surgical intervention in such cases. Therapeutic keratoplasty along with amniotic membrane provided an effective method of treating gonococcal-associated corneal melt and perforation, allowing for salvage of both globes. While the severity of this case is uncommon, it provides a precedent for the role of therapeutic keratoplasty in similar situations.