Abstract
Introduction:The study aims to report clinical results of tectonic keratoplasty for non-traumatic, non-infectious corneal perforations.Materials and Methods:The medical records of 12 patients who underwent tectonic penetrating keratoplasty between October 2014 and August 2018 at Ege University Ophthalmology Department were retrospectively reviewed.Results:The mean age of the patients was 52.92±30.34 (range, 2-82) years. The causes of corneal perforation were dry eye (neurotrophic keratopathy (n=4), limbal stem cell deficiency (n=2), exposure keratopathy (n=2) and graft versus host disease (n=1)) in 9 patients. In the remaining 3 patients, the etiology of perforation was not determined. The mean Visual Acuity (VA) was 2.98±0.39 (range, 1.8-3.1) LogMAR before the surgery. Despite conservative treatment, tectonic penetrating keratoplasty had to be performed in all patients in order to manage the perforation. Mean time in between initial examination and surgery was 10.75±12.04 (1-41) days. In 2 patients, allogenic limbal stem cell transplantation; in one patient, lateral tarsorrhaphy and in one patient symblepharon release with amniotic membrane transplantation were performed additional to tectonic keratoplasty. Mean follow-up time was 57.88±55.47 (4-141) weeks. Grafts were clear in 6 eyes and opaque in 5 eyes. The main causes of graft failure among opaque grafts were ocular surface disease (3), allograft rejection (1) and glaucoma-related endothelial failure (1). Phthisis bulbi was detected in one patient with congenital glaucoma due to vitreous loss at the time of perforation. The mean final VA in patients who had clear grafts was 1.83±1.03 (range, 0.8-3.1) LogMAR.Conclusion:To prevent serious complications in non-traumatic, non-infectious corneal perforations, providing anatomic integrity immediately is a must. If conservative treatment is inadequate or the perforation area is extensive, tectonic penetrating keratoplasty is indicated. Besides, it is important to manage the etiological risk factors in order to obtain successful clinical follow up.
Highlights
IntroductionThe study aims to report clinical results of tectonic keratoplasty for non-traumatic, non-infectious corneal perforations
The aim of this study is to report the clinical results of tectonic keratoplasty for non-traumatic, non-infectious corneal perforations
The cause of corneal perforation was a dry eye in nine patients
Summary
The study aims to report clinical results of tectonic keratoplasty for non-traumatic, non-infectious corneal perforations. Corneal perforation is a severe corneal emergency that can occur due to traumatic or non-traumatic (infectious/noninfectious) causes [1]. There are serious complications such as cataract formation, glaucoma development, endophthalmitis, and globe loss due to corneal perforation and clinicians should be aware of these devastating complications. Restoration of the Conservative treatments such as bandage contact lenses and pressure patching can be used to tamponade the leak. If conservative approaches are inefficient, surgical treatments such as multilayered amniotic membrane transplantation, conjunctival flaps and tectonic penetrating keratoplasty can be performed [2]. The preferred treatment modality is mostly based on size and the location of the perforation site. Large and central perforations generally require tectonic penetrating keratoplasty.
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