Sclerokeratoplasty as the Therapy for Corneal Perforation due to Exposure and Neurotrophic Keratopathy

Abstract

A case report of exposure and neurotrophic keratopathy after acoustic neuroma surgery resulting in perforation if not managed appropriately and timely is presented. Sclerokeratoplasty on 360 degrees may be an effective treatment method of corneal perforation in complete anaesthetic cornea when the standard penetrating keratoplasty failed. At a 12-month follow-up, the patient is doing well. UCVA is 0.5, the IOP is normal, and the graft remains clear. Systemic immunosuppression is the main disadvantage of this method. Further investigation is needed to assess the effectiveness and safety of this method.

Total Penetrating Keratoplasty: Indications, Therapeutic Approach, and Long-Term Follow-Up

“…Systemic immunosuppression, and often multidrug therapy, is necessary to minimize the risk of graft rejection and the necessity of repeat tectonic surgical treatment. There are no clear schemes concerning immunosuppressive treatment after CSPG [ 5 , 12 , 19 , 20 ].…”

“…Also, coexistent or causative infection or inflammation may determine the choice and timing of surgical decisions. Additional surgical procedures like amniotic membrane transplants, conjunctival flaps, tarsorrhaphy, and botulin toxin-induced ptosis may be applied in moderate tissue damage or as the initial treatment method [ 5 , 7 , 8 ].…”

“…The use of steroids and other immunosuppressive agents significantly reduces the rate of immunological graft rejections. Causative and complimentary intensive medication is necessary to avoid surgical treatment failure, which would lead to severe visual loss or even loss of the eye globe [ 5 , 12 , 17 , 18 ].…”

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

“…ere are several known predisposing factors leading to serious stromal dissolution and disintegrity of the globe. ese include infection, Sjögren syndrome, systemic disease, sterile inflammation, Stevens-Johnson syndrome, tear-film abnormality, prior ocular surgery, collagen vascular disease, neurotrophic keratopathy, persistent epithelial defect, chemical or thermal injury of the ocular surface, and use of topical medications that contain preservatives [1][2][3][4][5][6][7][8][9].…”

“…eir proteolytic activity can regulate proand anti-inflammatory cascades and are also regulative in the processes of tissue remodelling. e MMPs are shown to have a role in infectious and noninfectious causes of corneal tissue destruction [9][10][11]. e management and timing of corneal melting, ulceration, and consecutive perforation depends on the cause, size, corneal infiltration, location of perforation, and status of other ocular tissues [12,13].…”