Individual lamellar keratoplasty for Mooren's ulcer

Abstract

Objective To explore the indications, efficacy, and complications from different types of lamellar keratoplasty (LKP) for Mooren's corneal ulcers.Methods It was a retrospective case series study.Twenty-six patients (31 eyes) with Mooren's corneal ulcers underwent crescent LKP (14 eyes),D-shaped LKP (7 eyes),ring-shaped LKP (3 eyes),or total LKP (7 eyes) at Zhongshan Ophthalmic Center between January 2008 and June 2011.The selection of surgical procedures was based on the size and shape of the corneal ulceration.Best corrected visual acuity (BCVA),corneal graft clarity, astigmatism, and complications after the operation were studied during the follow-up period of 6-36 months.Results Patients with the BCVA between 0.3-0.5 after operation including,crescent LKP (3 eyes),D-shaped LKP (4 eyes),total LKP (5 eyes).Patients with the BCVA between 0.6-1.0 after operation including,crescent LKP (ll eyes),D-shaped LKP (3 eyes),ring-shaped LKP (3 eyes),total LKP (5 eyes).Visual acuity in 17eyes (54％) was improved after LKP,12 eyes (40％)remained the same,while 2 eyes (6％) decreased after operation.The mean corneal astigmatism in the ring-shaped graft group was 2.30±0.40 D,and 3.70±1.03 D in the D-shaped graft group 6 months after the operation.Postoperative complications included corneal epithelium defect in 4 eyes (13％),recurrence of Mooren's ulcer in 2 eyes (6％),suture-related corneal abscess in 1 eye (3％),and graft rejection in 4 eyes (13％).Conclusion LKP is effective in restoring the integrity of eyes with Mooren'sulcer.Designing the appropriate type of LKP based on the different shapes of corneal ulceration allows the removal of the corneal lesion and spares the maximum amount of normal tissue.Furthermore,a well-matched graft configuration can reduce surgically related astigmatism, and help to improve vision in most cases. Key words: Mooren's ulcer; Lamellar keratoplasty; Postoperative complication; Astigmatism