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Corneal Biofilm Plaques

A Novel Clinical Presentation

Córdoba, Andrea, MD*; Graue-Hernandez, Enrique O., MD, MSc, FACS*; Bermudez-Magner, Jose A., MD, FICO; Ramirez-Miranda, Arturo, MD*; Irusteta, Leire, MD*; Bautista-de Lucio, Victor M., PhD; Ponce-Angulo, Diana G., MSc; Bautista-Hernandez, Luis A., MsC; Navas, Alejandro, MD, PhD, FACS*

doi: 10.1097/ICO.0000000000001923
Case Report

Purpose: To report a novel clinical presentation of corneal biofilms, consisting of formation of superficial and recurrent corneal plaques.

Methods: Interventional case report. A 9-year-old boy presented with subepithelial, whitish, avascular, and recurrent corneal plaques without any clinical manifestations of active corneal inflammation and/or infection. He had a history of minor ocular trauma; otherwise, his medical history was unremarkable.

Results: An excisional biopsy was performed under topical anesthesia. Histological analysis identified these plaques as clusters of gram-negative bacilli surrounded by an extracellular matrix. Samples were further evaluated with special stains (calcofluor white, Flamingo fluorescent dye, propidium iodide, and Gomori–Grocott) that demonstrated biofilm structures.

Conclusions: Corneal plaques are a very rare clinical presentation of corneal biofilms that allow prolonged survival of microorganisms even in the absence of prosthetic material and clinical signs or symptoms of corneal active inflammation and/or infection.

*Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana,” Mexico City, Mexico,

Department of Ocular Pathology, Institute of Ophthalmology “Conde de Valenciana,” Mexico City, Mexico, and

Department of Microbiology, Institute of Ophthalmology “Conde de Valenciana”, Mexico City, Mexico.

Correspondence: Alejandro Navas, MD, PhD, FACS, Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana," Chimalpopoca 14, Cuauhtémoc 06800, Mexico City, Mexico (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received December 04, 2018

Received in revised form January 12, 2019

Accepted January 24, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.