Tectonic Eccentric Penetrating Sclerokeratoplasty à chaud as Treatment for Peripheral Perforated or Predescemetal Corneal Ulceration.

Abstract

Tectonic eccentric sclerokeratoplasty à chaud is a very complex corneal operation and aims to preserve the eyeball and possibly to improve visual acuity in patients with peripheral corneal ulcerations or perforating corneal trauma. 1650 eyes received corneal transplants in our clinic between 2006 and 2019. 14 of these 1650 eyes (0.8%) had a perforated or predescemetal peripheral corneal ulceration and these were treated between 2006 and 2019 with a tectonic eccentric sclerokeratoplasty à chaud. The mean age of the 8 women and 6 men included in this case series was 63years (22 - 91 years). In the postoperative follow-up period, most complications and reoperations occurred in the first 6 months. Re-ulceration was observed in 2 cases as well as early suture loosening in 12 patients. These 2 cases were treated with a partial conjunctival flap. Additionally, prolonged superficial wound healing process was shown in 12 patients. Therefore 27 amniotic membrane transplantations, 12 suture replacements, and 6 partial conjunctival flaps were performed in total. No re-keratoplasties were required in this case series. All eyes could be stabilised through the sclerokeratoplasty as well as subsequent operations and intensive local or even systemic treatment. After removal of the corneal suture, the best-corrected visual acuity improved only insignificantly to hand movement in 1 case, finger counting in 3 cases, 0.1 in 5 cases, 0.2 in 4 cases and 0.5 in 1 case. Preservation of the eyeball with pain relief was achieved in all 14 eyes. Eccentric sclerokeratoplasty is a very demanding surgical procedure and is extremely rarely performed. The goal is to preserve the eye.