Two cases of bacterial corneal ulcer occurring in eyes with bullous keratopathy

We report 2 cases of bacterial corneal ulcer occurring in eyes with bullous keratopathy. The first case was a 59-year-old female who visited the Department of Ophthalmology at Nagoya University Hospital with the complaint of severe pain in her left eye. She had undergone vitrectomy bilaterally to treat proliferative diabetic retinopathy, followed by development of bullous keratopathy in her left eye. A corneal ulcer was found in her left eye, and Streptococcus pneumoniae was isolated from scrapings taken from the ulcer. Treatment with topical erythromycin and sulbenicillin and systemic cefazolin resulted in the corneal ulcer subsiding in 3 weeks. The second case was a 65-year-old female who developed a corneal ulcer in her left eye while awaiting corneal transplantation for bilateral bullous keratopathy caused by argon laser iridotomy. Streptococcus pneumoniae was isolated from the lesion, which healed in 2 weeks with treatment with topical sulbenicillin and norfloxacin. The corneal ulcer may have been aggravated in the first case by diabetes mellitus and topical steroid and in the second case by trichiasis. Physicians following patients with bullous keratopathy need to be aware that a sudden change can signal the presence of an infectious corneal disorder.