{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:01:50Z","timestamp":1776351710899,"version":"3.51.2"},"reference-count":8,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Rapidly progressive infectious keratitis may involve the anterior uveal tract and lead to anterior segment inflammation, resulting in severe structural damage of the cornea and potentially causing corneal perforation or endophthalmitis if not promptly treated. We report the case of a 63-year-old male admitted to the Emergency Ophthalmology Department of the University Clinical Center in Katowice, Poland, with a rapidly progressive corneal ulcer of the left eye that had not responded to two weeks of outpatient topical antibiotic therapy. The condition developed after ocular trauma sustained while chopping wood. At presentation, visual acuity was limited to light perception with preserved projection. Multimodal imaging, including slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy, revealed extensive corneal ulceration with severe stromal destruction, progressive corneal melting, and marked anterior segment inflammation, with an imminent risk of perforation. Microbiological cultures identified Pseudomonas aeruginosa. Despite intensive empiric topical antimicrobial therapy targeting both bacterial infection and a possible fungal component related to trauma with organic material, rapid clinical deterioration necessitated emergency therapeutic penetrating keratoplasty (PK). The procedure resulted in rapid resolution of inflammation and improvement in visual acuity, with best-corrected visual acuity (BCVA) reaching 0.3 logMAR during follow-up. At the three-month follow-up, the corneal graft remained clear with stable visual acuity and no recurrence of infection. The patient remains under regular long-term follow-up, with ongoing monitoring of graft clarity, intraocular pressure (IOP), and visual function. This case differs from routine presentations of infectious keratitis by demonstrating exceptionally rapid stromal melting despite promptly initiated empiric topical therapy. Multimodal imaging, particularly AS-OCT provided clinically meaningful information by revealing structural instability and an imminent risk of perforation not fully appreciable on slit-lamp examination, thereby supporting timely urgent keratoplasty. These findings highlight the practical diagnostic value of imaging-based assessment in advanced infectious keratitis and underscore its role in guiding surgical decision-making in eyes at high risk of corneal perforation.<\/jats:p>","DOI":"10.3390\/diagnostics16081189","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:05:36Z","timestamp":1776348336000},"page":"1189","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anterior Segment OCT in Fulminant Pseudomonas aeruginosa Corneal Ulcer with Stromal Melting Requiring Emergency Penetrating Keratoplasty"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8266-1803","authenticated-orcid":false,"given":"Wojciech","family":"Lubo\u0144","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medical Sciences, Medical University of Silesia, 40-514 Katowice, Poland"},{"name":"Department of Ophthalmology, Professor K. Gibi\u0144ski University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7826-2906","authenticated-orcid":false,"given":"Monika","family":"Sarnat-Kucharczyk","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medical Sciences, Medical University of Silesia, 40-514 Katowice, Poland"},{"name":"Department of Ophthalmology, Professor K. Gibi\u0144ski University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariola","family":"Dorecka","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Faculty of Medical Sciences, Medical University of Silesia, 40-514 Katowice, Poland"},{"name":"Department of Ophthalmology, Professor K. Gibi\u0144ski University Clinical Center, Medical University of Silesia, 40-514 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gheorghe, A.G., Arghirescu, A.M., Marinescu, M.C., Onofrei, A.G., Pop, D.M., Voinea, L.M., and Ciuluvic\u0103, R.C. (2025). In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography in Optimizing Diagnosis and Therapeutic Management in Fungal Keratitis: Case Reports and Literature Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14228066"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Farhadi, F., Salehi-Pourmehr, H., Arasteh, A., Taheri, N., Pashazadeh, F., and Mostafaie, A. (2025). Corneal cross-linking for infectious keratitis of various causes: An umbrella review. BMC Ophthalmol., 25.","DOI":"10.1186\/s12886-025-04038-3"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jtos.2021.09.005","article-title":"Surgical management of infectious keratitis","volume":"28","author":"Said","year":"2023","journal-title":"Ocul. Surf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajo.2025.08.003","article-title":"Large-Diameter Optical Penetrating Keratoplasty: Indications, Mid-term Outcomes, and Literature Review","volume":"280","author":"Agarwal","year":"2025","journal-title":"Am. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Yang, Y., Zeng, H., Gong, L., and Lin, T. (2024). Risk Factors for Graft Failure After Penetrating Keratoplasty in Eastern China from 2018 to 2021. Ann. Transplant., 29.","DOI":"10.12659\/AOT.945388"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Antonopoulou, N.I., Spyropoulou, M.S., Papadakos, S.P., Papavasileiou, G.N., and Dimakis, A.C. (2026). Bridging gaps in corneal ulcer management: Can photoactivated chromophore for infectious keratitis-corneal collagen cross-linking delay or replace therapeutic keratoplasty?. World J. Transplant., 16.","DOI":"10.5500\/wjt.v16.i1.109740"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hohnen, H., Davidoss, N., Wiffen, S., Radinger, A., Tan, S.J., Gardam, D., and Ang, A. (2025). Retrospective Review of Fungal Keratitis at Two Tertiary Hospitals in Perth, Western Australia Between 2006 and 2022. Mycoses, 68.","DOI":"10.1111\/myc.70071"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Misra, S., Sharma, S., Barik, M.R., Rani, N., Das, S., Sahu, S.K., Priyadarshini, S.R., and Behera, H.S. (2025). 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Infect., 15.","DOI":"10.1186\/s12348-025-00479-5"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/8\/1189\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:14:10Z","timestamp":1776348850000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/8\/1189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":8,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["diagnostics16081189"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16081189","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}