Corneal melting and perforation under topical moxifloxacin and tobramycin: case report

PurposeTo describe a case of corneal melting with perforation after treating a corneal abscess with topical moxifloxacin + tobramycin for 2 weeks.MethodsRetrospective case report.ResultsA 56 year old patient presented 5 weeks after a retinal surgery with a central corneal abscess. Topical tobramycin 0.3% + moxifloxacin 0.5% 1/h + desomedine 1% 8/days was initiated and tapered 3 days later to 1/h, 5/days and 5/days respectively. Four days later a large erosion (3.5 × 3.5 mm) appeared while the abscess had disappeared. Topical tobramycin 5/days and moxifloxacin 3/days were continued for 1 more week when the patient presented to our clinic with a large corneal melting (3 × 2 mm) in a clear cornea that perforated centrally (1 × 1 mm) the next day with Descemet folds, fibrin, anterior cells ++, and, dilated iris vessels and posterior synechiae. Both blood tests and medical history were otherwise unremarkable. Moxifloxacin and tobramycin were discontinued and replaced by preservative free ofloxacin 0.3%1/h tapered quickly, tropicamide 3/days, oral valaciclovir (3 g/day), oral levofloxacin 500 mg/days and therapeutic lens. All cultures for bacteria, virus, amoeba or fungi as well as PCR for HsV1, HsV2 and VZV from corneal smear remained negative. Systemic treatment was consequently stopped, cornea healed quickly and therapeutic lens could be removed after a 3 days. No recurrence has been observed for the next 2 months.ConclusionsThis case suggests that topical moxifloxacin (combined with tobramycin) may inhibit the healing of corneal ulcers and induce a corneal melting leading to perforation.