Lamellar keratoplasty for treatment of peripheral corneal perforation

Abstract

To explore the indications, efficacy, and complications of different types of lamellar keratoplasty (LKP) for peripheral corneal perforation. In our nonrandomized retrospective case series, 40 cases (42 eyes) with peripheral corneal perforation at Zhongshan Ophthalmic Center between January 2003 and June 2006 underwent semi lunar LKP (14 eyes), crescent LKP (11 eyes), biconvex LKP (7 eyes), ring-shaped LKP (5 eyes), and total LKP (5 eyes). The selection of various procedures was based on the size and shape of corneal ulceration and perforation. Postoperative visual acuity (VA), corneal clarity, astigmatism, and complications were studied during a follow-up of 3 to 21 months. The initial causes and recurrence for peripheral corneal perforation were analyzed. The initial causes of corneal perforation were mostly Terrien's marginal degeneration (35.7%), Mooren's ulcer (31.0%), herpes simplex keratitis (11.9%), chemical/thermal burns (9.5%), and corneal ecstatic diseases (7. 1%). The lamellar graft attached to the host well and was transparent in 34 eyes (81.0%) following LKP. VA less than 0.1 were presented in 13 eyes (31.0%) preoperatively and in 3 eyes (7.1%) postoperatively. VA in 27 eyes (64.3%) improved after LKP, and best-corrected VA in nine eyes (21.4%) was 0.5 or better. The mean corneal astigmatism was (7.23 +/- 1.22) D three months postoperatively, and this decreased to (3.72 +/-1.76) D in six to nine months postoperatively when sutures were removed. The postoperative complications included graft-host interface effusion (8 eyes, 19.1%), secondary glaucoma (8 eyes, 19.1%) and reoccurrence of primary diseases, including Mooren's ulcer (3 eyes, 23. 1%) and herpes simplex keratitis (1 eye, 20.0%). LKP is effective to restore the integrity of the eyes with peripheral corneal perforation. Choosing the appropriate type of LKP based on different shape of corneal perforations can remove the corneal lesion and spare the normal tissue to the maximum. Moreover, the well-matched graft configuration can reduce the postoperative astigmatism, helping restore or improve the vision in most cases.