Different modalities for management of peripheral corneal ulcer

Abstract

Background The peripheral cornea has unique features, which make it more vulnerable to inflammatory reactions and necrosis. Peripheral corneal ulcer is caused by various infectious and noninfectious ocular and systemic diseases. It may impair vision by inducing astigmatism and ulcer progression to the center or threaten the eyeball integrity by spontaneous perforation. So, early diagnosis and proper treatment prevent blindness. Aim To evaluate different modalities for management of peripheral corneal ulcer. Patients and methods In this prospective study, 30 eyes of 29 patients having peripheral corneal ulcer were evaluated and treated with medical treatment and surgical intervention as adjunctive therapy in resistant cases. The duration of the study was 6 months with a follow-up period of 3 months. Results Of 30 eyes, 14 responded to medical treatment, with complete epithelial healing ranging from 2 to 6 weeks, with a mean of 3.36 ± 1.34 weeks. On the contrary, 16 of 30 eyes were resistant within 2 weeks and underwent surgical interference. A total of seven eyes were managed by amniotic membrane transplantation, and nine eyes were treated with tectonic keratoplasty. Time of healing ranged from 4 to 14 weeks, with a mean of 9.38 ± 3.91. All eyes showed anatomically successful outcomes. Conclusion Mild infectious peripheral keratitis heals on medical treatment. Cases of moderate infectious peripheral keratitis with history of diabetes mellitus or exposure keratitis need amniotic membrane transplantation as adjunctive therapy. Severe noninfectious cases with history of rheumatoid arthritis or Mooren’s ulcer need systemic treatment and tectonic keratoplasty.