{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T20:34:30Z","timestamp":1777581270934,"version":"3.51.4"},"reference-count":16,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T00:00:00Z","timestamp":1559088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Ophthalmology"],"published-print":{"date-parts":[[2021,1]]},"abstract":"\n Purpose:<\/jats:title>\n The aim of this study was to report a case of sterile corneal ulcer leading to perforation, which was treated effectively with autologous serum eye drops, topical regenerative agent (poly-carboxymethylglucose sulfate), steroids, and systemic immunosuppression in a patient with undiagnosed primary Sj\u00f6gren\u2019s syndrome.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A 74-year-old female presented with a month\u2019s history of gradually worsening blurry vision in her left eye. Ophthalmic examination revealed a central descemetocele with excessive corneal stromal melting and absence of signs of infection. A bandage contact lens was applied for tectonic support along with topical corticosteroid and antibiotic drops. Autoimmune screen disclosed a diagnosis of Sj\u00f6gren\u2019s syndrome, and the patient was commenced on systemic immunosuppression. Forty-eight hours after presentation, the patient developed a localized corneal perforation, presenting with a flat anterior chamber.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Urgent amniotic membrane transplantation was arranged while topical dexamethasone, moxifloxacin, and autologous serum eye drops were administered. After 24\u2009h of intensive topical treatment, a significant reforming of the anterior chamber and subsequent gradual regeneration of the corneal stroma were noted, thus postponing amniotic grafting. The patient remained under close monitoring, showing progressive clinical improvement. Regenerating agent eye drops (Cacicol20\n \u00ae<\/jats:sup>\n ) were also applied over the next month, with careful and slow tapering of topical dexamethasone. Further improvement of corneal thickness was observed, and visual acuity increased to 20\/80.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n This case report demonstrates the successful medical treatment of an autoimmune-related sterile corneal perforation without surgical intervention, highlighting the fact that early diagnosis and rigorous medical treatment with autologous serum and regenerating agent eye drops can effectively aid tissue regeneration and favorable visual rehabilitation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1120672119853106","type":"journal-article","created":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T04:51:02Z","timestamp":1559105462000},"page":"NP17-NP21","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Treatment of spontaneous corneal perforation secondary to undiagnosed Sj\u00f6gren\u2019s syndrome using regenerating agent and autologous serum eye drops"],"prefix":"10.1177","volume":"31","author":[{"given":"Argyrios","family":"Tzamalis","sequence":"first","affiliation":[{"name":"2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece"},{"name":"St. Paul\u2019s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Artemis","family":"Matsou","sequence":"additional","affiliation":[{"name":"2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleftherios","family":"Anastasopoulos","sequence":"additional","affiliation":[{"name":"2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Ziakas","sequence":"additional","affiliation":[{"name":"2nd Department of Ophthalmology, Faculty of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,5,29]]},"reference":[{"key":"bibr1-1120672119853106","volume-title":"Cornea","author":"Krachmer JH","year":"2011","edition":"3"},{"issue":"3","key":"bibr2-1120672119853106","first-page":"214","volume":"79","author":"Whitcher JP","year":"2001","journal-title":"Bull World Health Organ"},{"issue":"13","key":"bibr3-1120672119853106","first-page":"3221","volume":"32","author":"Matsubara M","year":"1991","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"7","key":"bibr4-1120672119853106","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.ophtha.2010.12.016","volume":"118","author":"Akpek EK","year":"2011","journal-title":"Ophthalmology"},{"issue":"2","key":"bibr5-1120672119853106","first-page":"379","volume":"28","author":"Vivino FB","year":"2001","journal-title":"J Rheumatol"},{"key":"bibr6-1120672119853106","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-9071.2000.00351.x"},{"key":"bibr7-1120672119853106","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-200103000-00027"},{"key":"bibr8-1120672119853106","doi-asserted-by":"publisher","DOI":"10.1097\/01.ico.0000121709.58571.12"},{"key":"bibr9-1120672119853106","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-200003000-00002"},{"key":"bibr10-1120672119853106","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2003.026211"},{"key":"bibr11-1120672119853106","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-0124(12)70165-9"},{"key":"bibr12-1120672119853106","unstructured":"Laboratoires Thea. 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