Update on surgical management of corneal ulceration and perforation

Stamate, Alina-Cristina; Tătaru, Călin Petru; Zemba, M

doi:10.22336/rjo.2019.25

Cited by 37 publications

(34 citation statements)

References 22 publications

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“…AMs should be avoided in cases of active infection as they impede AC and fundus visualisation. Our observations and practices are consistent with that of other authors [1,24,25]. In cases of active infection, we prefer to perform PG after total removal of the infected and damaged corneal tissues.…”

Section: Journal Of Ophthalmologysupporting

confidence: 90%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…Nonsurgical treatments include reducing inflammation, addressing the underlying cause, using anticollagenases, treating coexistent infections, prescribing antiglaucoma treatments, and optimising epithelial healing (using bandage soft contact lenses, autologous serum eye drops, or lacrimal punctal occlusions). e diagnosis of corneal perforation can sometimes be difficult or even impossible as complex interactions exist between the different components of the ocular surface [1,2,14]. A wide range of conditions can, therefore, result in similar functional effects at the ocular surface.…”

Section: Introductionmentioning

confidence: 99%

“…If pharmacological treatments fail or are insufficient, surgery becomes the only possibility for restoring the structural integrity of the globe; it may also serve as an adjunct for another definitive treatment method. Surgical treatments for corneal perforation include tarsorrhaphy, tissue adhesives, corneal transplants, conjunctival flaps, tenon-derived patch grafts, amniotic membrane transplants (AMT), and therapeutic ptosis with botulinum toxin [1,3,7,16]. e surgical treatment of corneal perforation usually begins with a tectonic treatment to stabilise the eye.…”

Section: Introductionmentioning

confidence: 99%

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

Krysik¹,

Dobrowolski

Wylęgała

et al. 2020

Journal of Ophthalmology

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Purpose. To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored. Methods. A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications. Results. We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation. Conclusions. The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone.

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Section: Journal Of Ophthalmologysupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Krysik¹,

Dobrowolski

Wylęgała

et al. 2020

Journal of Ophthalmology

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“…This clinical condition can have vision-threatening consequences if not treated appropriately and promptly during the acute phase [2]. Patients can have significant complications such as corneal perforation, which can lead to development of severe ocular morbidities like glaucoma, cataracts, or synechiae, leading to vision loss [3]. Endophthalmitis and related loss of vision can also be a consequence of an untreated corneal ulcer [4].…”

Section: Introductionmentioning

confidence: 99%

Corneal Ulcer Treated with 0.66% Nanoemulsion Povidone-Iodine: A Case Report

Bordin

2020

Am J Case Rep

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Unusual clinical course Background: Corneal ulceration is caused by various corneal diseases, including infection, inflammatory disease, neurotrophic keratitis, dry-eye, autoimmune disease, and blepharitis. Treatment should be based on the etiology. In cases of infection, corneal scraping and pathogen culture should be carried out before treatment. Bacterial pathogens are the most common etiology, but it can be caused also by viruses, fungi, and protozoa. Quinolones are the first-line drug for bacterial keratitis, but the treatment should be changed according to the culture and drug sensitivity test results. The purpose of this case report is to show the resolution of a corneal ulcer case unusually treated with 0.66% povidone-iodine (PVP-I). Case Report: A 61-year-old man showed signs of pain, redness, watering, and photophobia in the left eye (oculus sinister; OS) over a 5-month period, starting as conjunctivitis and degenerating into keratitis. Clinical examination revealed an ulcer in the inferior cornea and biomicroscopy analysis confirmed this diagnosis. Previous therapies, starting with antibiotics first and then antiviral medications, were unable to control the signs and symptoms. Therefore, treatment with 0.66% PVP-I, based on its antiseptic activity, was administered 3 times a day for 4 weeks. Conclusions: PVP-I 0.66%, an antiseptic with broad-spectrum activity against bacteria, fungi, viruses, and protozoa, was found to be effective in treating the signs and symptoms of the ulcer until its complete closure and resolution. It could be a useful therapeutic tool when the pathogen is unknown, as in this case. Its use for treatment of corneal ulcers warrants further investigation.

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