Peripheral ulcerative keratitis: a rare case after beetle in
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The present case has been reported in the Indian Journal of Ophthalmology.

A 53-year-old male presented to our outpatient services with left eye (LE) redness, pain, and swelling since 3 days. He gave a history of accidental contact with some insect while farming. Best corrected visual acuity (BCVA) was 6/12 in both eyes at presentation. Examination of the right eye (RE) revealed immature cataract with rest of the anterior segment being normal. Examination of the LE revealed lid edema with marked conjunctival congestion and peripheral keratitis extending 2 clock hours from 3'0 clock to 5'0 clock, sparing the pupillary area.

There was a foreign body (FB) lodged in the marginal cornea at 4'0 clock location (presumably an insect shell). The FB [Figure 1] was removed with a 26-G needle under topical anesthesia. Following removal, slit beam examination of LE revealed crescent-shaped peripheral corneal melt with steep edges and exposed bare Descemet's membrane, surrounded by diffuse keratitis.

LE corneal scraping for staining and culture was negative with no evidence of any infectious etiology. Patient was started on hourly topical moxifloxacin hydrochloride 0.5% and tobramycin empirically. The FB was sent to the entomologist of our local veterinary hospital to determine the probable insect. Entomological studies confirmed it to be the exoskeleton of Paederus spp. belonging to the order Coleoptera.

On follow-up visit after 2 days, LE vision deteriorated to HM+ with increased pain and redness. On examination, there was total corneal abscess, with marked conjunctival congestion. The patient was counseled for urgent need of therapeutic penetrating keratoplasty, and was followed up by surgery the next day.

The trephined host corneal button was sent for microbiological examination and was again negative for any infectious etiology. Postoperatively, the patient was started on topical steroids 0.1% prednisolone acetate eye drops hourly and topical moxifloxacin four times per day. The patient recovered well with a BCVA of 6/60 in LE at 2 weeks postoperatively. At 6 weeks, patient's (LE) BCVA was 6/60 with immature cataract, and he is on regular follow-up.

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