Differences in Surgical Management of Corneal Perforations, Measured over Six Years

Abstract

Purpose. To report the surgical approach, anatomical and functional results, and complications in the group of patients with corneal perforation. Materials and Methods. 247 eyes with corneal perforation were operated on between January 2010 and July 2016. The three surgical procedures, dependent on size and location of perforation, were performed: full-sized penetrating keratoplasty, corneoscleral patch graft, and anterior lamellar keratoplasty. The eyes underwent the minimum 6-month follow-up visit. Results. Between January 2010 and July 2016, 247 surgeries were performed: 116 penetrating keratoplasties, 117 corneoscleral patch grafts, and 14 anterior lamellar keratoplasties. More than one procedure was necessary in 32 eyes. Final improvement of the visual acuity, within a gain of 2 or more lines with the Snellen test, was achieved in 56 operated eyes. To achieve better final visual acuity, 75 eyes required successive surgical treatment. Complications of the surgery comprised persistent epithelial defect, glaucoma or ocular hypertension, corneal oedema, graft melting, loose corneal sutures, reinfection, anterior synechiae and fibrinoid membranes, and endophthalmitis. In 26 eyes, the treatment failure was reported. Conclusions. There is no one general-purpose surgical technique to treat corneal perforations. The complex nature of this pathology remains the individual, careful but also very distinct and multifactorial approach.

Amniotic Membrane as a Main Component in Treatments Supporting Healing and Patch Grafts in Corneal Melting and Perforations

“…It is an adequate treatment in cases of anterior chamber tissue exposure. Total grafts should be applied only in advanced necrosis or in keratitis that is unresponsive to pharmacological treatment [26,27]. Because of the heterogeneity of the causes of corneal melting, there is no single universal treatment method for corneal perforation.…”

Individualized penetrating keratoplasty using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers

“…When corneal perforation occurs, patients need appropriate and immediate treatments to preserve the anatomic integrity of the cornea, and to prevent complications such as secondary glaucoma or endophthalmitis [3]. Many treatments can be used in perforated corneal disorders, including nonsurgical approaches (limiting inflammation, treating a coexistent infection, anti-collagenase and antiglaucoma treatment, optimizing epithelial healing using bandage soft contact lenses and autologous serum eye drops [3–5], and pressure bandaging), and surgical treatments (tissue adhesives, amniotic membrane transplants (AMT), conjunctival flaps, pericardial membranes, tarsorrhaphy, therapeutic ptosis with botulinum toxin, lamellar keratoplasty (LK), and penetrating keratoplasty (PK) [3, 4, 6–12]). The treatment selection mainly depends on the size and location of the perforation and the status of the underlying disease [3].…”

Tectonic Deep Anterior Lamellar Keratoplasty to Treat Corneal Perforation and Descemetocele from Microbial Keratitis

“…7 Defect location was categorized as central (involving visual axis, ≤5.0mm diameter of the central cornea), paracentral (zone over 5.0mm up to 8.0mm) or peripheral (≥8.0mm), also including the limbus. 8 Post-operative outcomes included: BCVA, surgical outcome, graft transparency and complications. Success was defined as resolution of infection and preservation of ocular integrity.…”

“… 7 Defect location was categorized as central (involving visual axis, ≤5.0mm diameter of the central cornea), paracentral (zone over 5.0mm up to 8.0mm) or peripheral (≥8.0mm), also including the limbus. 8 …”