Perforated Corneal Ulcer Research Articles

To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute.

Purpose:To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute.Methods:Records of all the patients who presented from March 25th to May 3rd, 2020 were scanned to evaluate the details regarding the presenting complaints, diagnosis, advised treatment and surgical interventions.Results:The number of outpatient department visits, retinal laser procedures, intravitreal injections and cataract surgeries during this lockdown decreased by 96.5%, 96.5%, 98.7% and 99.7% respectively compared from the corresponding time last year. Around 38.8% patients could be triaged as non-emergency cases based on history alone while 59.5% patients could be triaged as non-emergency cases after examination. Only eighty-four patients opted for video-consultation from April 15th to May 3rd, 2020. Nine patients presented with perforated corneal ulcer, but could not undergo penetrating keratoplasty due to the lack to available donor corneal tissue. One of these patients had to undergo evisceration due to disease progression. Two patients with open globe injury presented late after trauma and had to undergo enucleation. Around 9% patients could not undergo the advised urgent procedure due to logistical issues related to the lockdown.Conclusion:A significant number of patients could not get adequate treatment during the lockdown period. Hospitals need to build capacity to cater to the expected patient surge post-COVID-19-era, especially those requiring immediate in-person attention. A large number of patients can be classified as non-emergency cases. These patients need to be encouraged to follow-up via video-consultation to carve adequate in-person time for the high-risk patients.

Clinical efficacy of enucleation with packet-covered hydroxyapatite implant

Objective To evaluate the efficacy of enucleation with packet-covered hydroxyapatite implant. Methods The data of 45 eyes of 45 patients who were treated with enucleation with packet-covered hydroxyapatite implantation in our hospital from Jul.2011 to Aug.2017 were retrospectively analyzed. Postoperative follow-up was 12 months. Results Among 45 patients, there were 5 cases with traumatic severe ocular rupture, 9 cases with neovascular glaucoma, 26 cases with keroscleral grape swelling, and 5 cases with severe corneal ulcer perforation. After operation, mild lower eyelid relaxation occurred in 2 cases.No other complication, such as exposure of prosthetic ocular platform occured. All the patients had beautiful eyes. Conclusion Implantation of packet-covered hydroxyapatite with four rectus musles covered is simple and effective.The complications such as hydroxyapatite exposure is not easy to occur. Key words: Hydroxyapatite implantation; Muscle cone; Exposure

Individualized penetrating keratoplasty using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers

PurposeTo report a surgical technique and the surgical outcomes of individualized penetrating keratoplasty (PK) using edge-trimmed glycerol-preserved donor corneas for perforated corneal ulcers.MethodsFourteen perforated eyes from 14 patients who underwent individualized PK using edge-trimmed glycerol-preserved donor corneas, were included in the retrospective study. The perforations were mainly 1–2 mm in size except for one that was 2.5 × 4 mm. Three patients were treated with PK; one patient was treated with PK and a conjunctival flap; ten patients who had large ulcer areas were treated with PK combined with lamellar keratoplasty (LK). Donor corneas were preserved in sterile pure glycerol at − 80 °C. Corneal grafts were specially edge-trimmed to match the perforation, and then sutured onto the recipient bed avoiding the visual axis.ResultsAll 14 patients recovered anatomical integrity without reinfections of the treated eyes. All patients had improved graft transparency and uncorrected visual acuity after surgery. Among them, four patients suffered from short-term postoperative complications and recovered quickly; four patients suffered from long-term postoperative complications, of them, one was performed further treatment.ConclusionAfter individualized PK using glycerol-preserved donor corneas, all perforated corneal ulcers were stably controlled by the end of the follow-up period. This modified surgical technique can be a potential treatment choice for patients with perforated corneal ulcers.

Outcomes of Therapeutic and Tectonic Penetrating Keratoplasty in Eyes with Perforated Infectious Corneal Ulcer

Objectives:To evaluate the outcomes of penetrating keratoplasty performed for therapeutic and tectonic purposes in eyes with perforated infectious corneal ulcer.Materials and Methods:This retrospective study included 43 eyes of 43 patients who developed perforated infectious corneal ulcer of various etiological causes between June 2008 and January 2018. The patients were evaluated based on age and sex, follow-up time, presence of corneal perforation, pre- and postoperative visual acuity, postoperative graft transparency, complications, and infection recurrence.Results:The mean age of the 43 patients was 52.9±13.8 years. The mean follow-up time was 2.7±1.3 years. Preoperatively, the visual acuity of the eyes was at the level of hand motions or counting fingers; postoperative best corrected visual acuity ranged from hand motions to 0.7. Postoperative complications included hyphema in 8 patients (18.6%), elevated intraocular pressure in 14 (32.5%), posterior synechiae in 18 (41.8%), and cataract in 22 patients (51%). Therapeutic and tectonic success was achieved in 42 patients (97.6%). Postoperative graft transparency was observed in 35 patients (83.3%) within the 1-year follow-up period and in 27 patients (71.0%) at 2 years. Among 27 patients with graft transparency, 23 had bacterial and 4 had viral etiologies (p=0.52); 16 patients had perforations smaller than 1 mm and 11 had perforations 1-3 mm in size (p=0.2).Conclusion:Therapeutic-tectonic keratoplasty for perforated infectious corneal ulcer successfully restored globe integrity in 97.6% of cases. The rate of graft transparency was 71.0% at 2 years, with no effect of etiological agent or perforation size.

A Rare Case of Left Sided Anophthalmos with Congenital Cystic Eyeball with Right Sided Microphthalmos

Congenital cystic eye, also known as anophthalmos with cyst, is an extremely rare congenital anomaly, first described by Mann in 1939 with a prevalence of 3 per 1,00,000. Congenital micropthalmos is also a rare condition with prevalence rates of 1.4 - 3.5 per 10,000 births. The objective is to report a case of a 19 year old male who was born to non-consanguineous marriage, presenting with left sided anophthalmos with right sided microphthalmos, with horizontal nystagmus and healed perforated corneal ulcer. Differential diagnosis include encephalocele, dermoid cyst, congenital cystic eye and tumors. Early visual rehabilitation is advised.

Graft Survival after Penetrating Keratoplasty in Cases of Trabeculectomy versus Ahmed Valve Implant.

Purpose To compare the corneal graft survival rates after penetrating keratoplasty (PKP) in cases of post-PKP glaucoma managed by either trabeculectomy with mitomycin C or Ahmed glaucoma valve (AGV). Methods This study was a retrospective interventional comparative study that included 40 eyes of 40 patients. The included patients had undergone previous PKP for anterior segment reconstruction after microbial or fungal keratitis, chemical burns, trauma, or perforated corneal ulcer. Post-PKP glaucoma was managed surgically by either trabeculectomy with mitomycin C (group 1) or Ahmed glaucoma valve (group 2). Results The first group (n=20) had undergone trabeculectomy with MMC, and the second group (n=20) had undergone AGV implantation. Regarding BCVA, there was no statistically significant difference between the 2 groups. Mean IOP was significantly lower in the AGV group at 6 months, 12 months, and 24 months (p=0.001). Mean IOP at 24 months dropped significantly from preglaucoma surgery levels in both groups (p=0.001). Rejection episodes occurred in 2 eyes (10%) of the trabeculectomy group versus 8 eyes (40%) in the AGV group (p=0.028). In the trabeculectomy group, corneal graft failure occurred in 1 (5%), 3 (15%), and 6 (30%) eyes at 6 months, 12 months, and 24 months, respectively. In the AGV group, corneal graft failure occurred in 2 (10%), 5 (25%), and 10 (50%) eyes at 6 months, 12 months, and 24 months, respectively. The mean time to failure in the trabeculectomy group was 12.33 ± 5.60 months versus 11.90 ± 5.70 months in the AGV group (p=0.027). Conclusion Managing postpenetrating keratoplasty glaucoma could be bothersome especially in complex cases. Ahmed glaucoma valve implant controls the intraocular pressure more effectively than trabeculectomy with mitomycin C. However, Ahmed glaucoma valve can result in higher rates of corneal graft failure in a shorter duration of time. This trial is registered with PACTR201712002861391 on 21 Dec 2017.

Clinical presentation and management of corneal fistula.

To describe the clinical features and management of corneal fistula in patients of healed keratitis. Medical records of all patients of healed keratitis presenting to the cornea clinic from November 2016 to September 2017 were reviewed. Eightcases of corneal fistula (six true fistulas, two closed fistulas) were identified. Six patients were managed with autologous tenon patch graft while two patients were managed medically. Various risk factors and treatment outcomes of corneal fistulisation were evaluated. The patients included two patients of failed therapeutic keratoplasty (with resolved graft infection) and six patients of healed keratitis. The age of the patients ranged between 10and60 years. Five of the patients were male while three were female. The size of the fistula measured between 1and2 mm. A surrounding cystic area of diameter ranging between 1and4.5 mm was seen in all the patients. In all of the patients, the treating physician missed the diagnosis. Complete healing was noted at 6-8 weeks in all the patients who underwent tenon graft. One patient refused to undergo any surgery and was lost to follow-up. In another case, surgery was deferred due to uncontrolled hypertension and he developed anterior staphyloma subsequently. Corneal fistula can often be missed in an apparently healed perforated corneal ulcer. Tenon patch graft is an effective technique for the management of corneal fistula.

Outcome of therapeutic penetrating keratoplasty in advanced infectious keratitis

PurposeThis study aimed to evaluate the anatomical, therapeutic, and functional outcome of therapeutic penetrating keratoplasty (TPK) in terms of success and failure. MethodsIn this retrospective study 57 eyes of 57 patients were reviewed. They had undergone TPK from December 2012 to June 2017. Data analyzed included the baseline demographic features and characteristics, preoperative diagnosis, and postoperative outcomes. The baseline characteristics included age, gender, laterality, indications of TPK, lens status, size of the recipient, grade of the graft, organisms identified, preoperative best corrected visual acuity (BCVA), secondary procedures, adjunctive surgical procedure, postoperative BCVA at last follow-up, intraocular pressure (IOP), and long-term complications of TPK. The ultimate outcome of TPK was observed in terms of anatomical, therapeutic, and functional outcome which indicated the success and failure. ResultsA total of 57 eyes of 57 with an age range of 2–76-year-old patients who underwent TPK were included in the study. Perforated corneal ulcer was a major indication of TPK in 32 (56.1%) cases. Anatomical success was obtained overall in 49 (85.96%) cases. Indications of TPK and preoperative visual acuity, complications of TPK, and ultimate graft clarity showed significant impact on the anatomical outcome (P = 0.03, P = 0.00, P = 0.00, and P = 0.05), respectively. The therapeutic and functional success was observed in 51 (89.47%) and 40 (70.17%) cases, respectively. ConclusionsPerforated corneal ulcers was the major indication for TPK. Indications and complications significantly affect the anatomical, therapeutic, and functional outcome.

Хирургическое лечение перфорации роговицы аутотканями: клинический случай

Purpose: to analyze the effectiveness of therapeutically covering cornea perforation in a cancer patient with auto conjunctiva. Material and methods. A patient with a diagnosis of cancer of the right kidney pT1N0M1, ST 4, metastasis in the left kidney and L 1-2 vertebrae; cancer rectum pT3N0M0, liver metastases in the form of a hypodense focus underwent several surgeries: radical nephrectomy of the right kidney; anterior resection of the rectum; atypical liver resection (S3, S4, S5). Over the 5-year period of treatment in an oncology hospital the patient received 48 courses of immunotherapy (the most recent session took place in June 2014). Starting from September 2014, the patient was treated for keratouveitis of both eyes. The vision of both eyes dropped drastically from 1.0 to 0.01 (uncorrected) in just 2 months. On April 6, 2015 the patient was admitted to the Ophthalmological hospital, diagnosed with corneal ulcer perforation complicated by a cataract of the right eye, corneal dystrophy of the cornea, and complicated cataract of the left eye. He was treated by covering corneal perforation with a flap of autoconjunctiva and blepharorhaphy of the right eye. Results. In the right eye, a vascularized wall-eye in the lower third of the cornea with a stable plugging effect was formed. On Sept. 24, 2015 (5.5 months after autoconjunctiva covering and blepharorrhaphy), cataract phacoemulsification with implantation of an intraocular lens in the right eye was performed (at the date of discharge, uncorrected OD vision was 0.1 not correct). On Nov. 23, 2015 the same procedure was repeated in the left eye (at discharge vis OS = 0.4 uncorrected). After 1.5 years, the vision remained stable (OD = 0.1, OS= 0,4 uncorrected). Conclusion. The clinical case demonstrates a high risk of corneal ulcer perforation in cancer patients caused by reduced immunity after chemotherapy. Eye preserving coverage of corneal perforation with an autoconjunctiva flap accompanied by blepharorhaphy showed a satisfactory result of sealing the perforation of the cornea. The vascularized wall-eye formed affected the optical part of the cornea with minimal losses, which later allowed performing a cataract extraction with the restoration of visual functions. For citation: Ivachev E.A. Surgical treatment of corneal perforation by auto tissue: a clinical case. Russian ophthalmological journal. 2018; 11 (1): 80-4. doi: 10.21516/2072-0076-2018-11-1-80-84 (In Russian).

The use of porcine urinary bladder matrix (UBM) to repair a perforated corneal ulcer with iris prolapse in a horse

SummaryThis report describes the use of porcine urinary bladder matrix (UBM) to repair a full thickness defect in the cornea of a Thoroughbred racehorse. The horse presented with acute keratomalacia of the right eye of 12 h duration that had rapidly progressed to perforation of the cornea with partial iris prolapse. The cornea was surgically debrided with the horse under general anaesthesia and the defect repaired with ACell multilayer wound matrix. A temporary tarsorrhaphy was performed. The defect in the cornea was successfully repaired and the horse regained vision in the eye. Four months after surgery the defect was still undergoing remodelling and the area of opacity in the cornea was progressively reducing.

Human immunodeficiency virus infection in a child presenting as herpes zoster ophthalmicus and non-healing keratitis

Herpes Zoster is produced by reactivation of latent varicella zoster from the dorsal root ganglion of sensory nerves. It is common in older individuals and rarely described in Pediatric age group. Its occurrence in younger age should be viewed with suspicion. We describe an 11-year-old Nepali child who presented with herpes zoster ophthalmicus of right half of the forehead and a perforated corneal ulcer in the right eye. On investigations he was found to have been infected with human immunodeficiency virus (HIV). Patient responded well to systemic acyclovir. Thus, herpes zoster ophthalmicus in a young child should be viewed with suspicion.

Use of glycerol-preserved corneas for corneal transplants.

Purpose:This study was carried out to see the results of glycerol-preserved cornea (GPC) in emergency situation when fresh corneal tissue was not available. The aim was to study the outcome of corneal transplantation using GPC.Methods:This was a retrospective study. The medical records of all the patients were reviewed, who underwent keratoplasty using “GPC” during the period from October 2011 to December 2015. The indication of keratoplasty, duration of preservation of the GPC, and its outcome were analyzed. Descriptive statistics were applied.Results:Out of the 222 penetrating keratoplasty (PKP) performed over the study period, the GPC was used in 34 patients (males = 31, 91.2%) aged 15–74 years. Therapeutic keratoplasty was performed in all cases in this cohort except one in which tectonic keratoplasty was done. The primary indication of PKP (91.2%) was infectious keratitis. Of these, 20 (64.5%) patients presented with perforated corneal ulcers. Post-PKP, ocular anatomy was preserved in 91.2%, and visual acuity of perception of light positive and accurate projection of rays in all the quadrants was obtained in 76.5% cases. Complications included glaucoma (n = 12, 35.1%), phthisis bulbi (n = 2, 5.9%), and graft reinfection and endophthalmitis after PKP (n = 1, 2.9%). The secondary procedure post-GPC and PKP were trabeculectomy with mitomycin C (n = 7, 58.3%) in patients not controlled on topical antiglaucoma medication. Optical keratoplasty was performed in (n = 3) 8.8% patients and triple procedure in (n = 2) 5.8% patients with good visual acuity postprocedure.Conclusions:Acellular GPCs are useful in emergency keratoplasty to avoid loss of vision and can save the eye.

Orbital implant exposure following enucleation or evisceration.

PURPOSE:To study the exposure rate of orbital implant postenucleation or evisceration procedures in two tertiary hospitals in Oman.DESIGN:A retrospective, descriptive, cross-section study.MATERIALS AND METHODS:Patients' records were reviewed for patients' demographics, surgical indications, implant types, follow-up and any reported complications after surgeries. Patients with a minimum of 1 year follow-up period were selected. All patients who underwent enucleation or evisceration with primary orbital implant were included in the study. Patients who underwent secondary orbital implant were excluded from the study.RESULTS:A total of 37 patients (age between 4 and 88-year-old, median age is 54-year-old) underwent enucleation or evisceration during 2008–2014. The most common indications for the surgical intervention were painful blind eye (35%), followed by trauma (16%), and perforated corneal ulcer (16%). Out of 37 patients, hydroxyapatite implant was implanted in 17 patients (46%), a glass or acrylic implant was implanted in 17 patients (46%), bioceramic implant was implanted in two patients (5%), and Molteno prosthesis was implanted in one patient (3%). There was no case of orbital implant exposure in any patients in this study.CONCLUSIONS:No orbital implant exposure was recorded in this study. The surgical technique, end to end rectus muscles suturing, used for enucleation/evisceration was the main reason for reduced implant exposure. In addition, the preexisting ocular pathology did not affect the outcome of the study.

E-PTFE Membran für die Behandlung von perforiertem Hornhautulkus

Purpose: To present the surgical management of perforated corneal ulcer using PRECLUDE® Pericardial Membrane, composed of expanded polytetrafluoroethylene (e-PTFE; GORE-TEX®), as an alternative surgical procedure in patients at high risk of graft rejections and to evaluate side effects for a prolonged period. Patients and Methods: The study included all patients who were admitted to our department and underwent surgical repair of perforated corneal ulcer with the e-PTFE membrane between 2010 and 2015. In total, 8 patients (8 eyes) were enrolled. Medical records of all patients were retrospectively reviewed. The operation was performed under peribulbar anaesthesia. Non-absorbable, microporous, watertight 0.1 mm thick e-PTFE membrane was used to close the corneal ulcer. The membrane was cut to overlap the defect adequately and to achieve the desired tissue attachment without preparing the conjunctiva or superficial trephination of the cornea. The membrane was fixed to the healthy cornea with several non-absorbable sutures (Prolene® 10.0), in order to achieve the proper stress without wrinkling. Results: Five of 8 patients were treated for systemic immunological diseases. Sjögren's syndrome was diagnosed in 2 patients, granulomatosis with polyangiitis in one, vasculitis with a history of previous sclerokeratitis in one and systemic lupus erythematosus in one. In 2 patients, corneal perforation was observed as a complication of corneal infection and in one patient as a late complication of a severe chemical burn. Corneal perforations were successfully covered with e-PTFE membrane in all patients. E-PTFE membrane was well tolerated in all patients and the eye was always preserved. After 3 to 4 months, the membrane was removed in 7 patients. The underlying cornea was thin, firm, stable and vascularised. In one patient with Sjögren's syndrome, the e-PTFE membrane is still in place. Conclusion: Surgical management of perforated corneal ulcer using E-PTFE membrane may be the method of choice for eye preservation or for delayed corneal transplantation. Our results confirmed that the procedure is safe and effective, especially in high risk patients. After removing the membrane, penetrating keratoplasty can be performed as a definitive treatment in all eyes where an improvement in visual acuity is expected.

Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States.

Purpose. To compare the long-term outcomes of infectious versus sterile perforated corneal ulcers after therapeutic penetrating keratoplasty in the United States. Methods. The charts of 45 consecutive eyes that underwent primary therapeutic penetrating keratoplasty for a perforated corneal ulcer at a single center were retrospectively reviewed. The perforated ulcers were classified as infectious or sterile and the underlying demographics, clinical features, and 36-month outcomes were compared among the two groups. Results. Mean follow-up among subjects was 38.6 (±6.9) months. Patients presenting with sterile perforated ulcers were more likely to have a peripheral perforation location (p = 0.0333) and recurrence of the underlying disease condition (p = 0.0321), require adjunctive surgical measures in the immediate postoperative period (p < 0.0001), have reperforation after keratoplasty (p = 0.0079), have worse best corrected visual acuity (p = 0.0130), develop no light perception vision (p = 0.0053), and require enucleation/evisceration (p = 0.0252) when compared to the infectious perforated ulcer group. Conclusions. Sterile perforated corneal ulcers have a worse prognosis and may be more frequent than those caused by infectious disease in the United States compared to the developing world.

Treatment of large corneal perforations with acellular multilayer of corneal stromal lenticules harvested from femtosecond laser lenticule extraction

To describe a novel surgical technique for the treatment of large corneal perforations by using acellular multilayer of corneal stromal lenticules. Prospective study. The acellular tissue used for the repair was harvested from myopic patients during the femtosecond laser (FS) refractive surgery. Informed consent, blood test and donor eligibility were obtained in each case. Three or four layers of lenticules were stacked up and stored at -80°C in pure sterile glycerin. The diameter is 6.0 to 6.5 mm and central thickness was 300 to 400 µm. If the diameter of the corneal ulcer perforation was larger than 3 mm and corneal grafts were not available, we used this kind of patches to seal the perforations. It was a retrospective case series study. Five cases of corneal ulcer perforation were enrolled in this study. One was neuropathic keratitis, one was atopic keratoconjunctivitis, and the other three were fungal keratitis. Acellular multilayer of stromal lenticules were used in these cases for emergent therapy. The sealing of the perforation and the re-establishment of the anterior chamber were achieved successfully in all the cases. For the pericentral perforations, visual recovery was achieved. And efficient palliative management was done for the central perforations. The reported technique seems to represent a good alternative emergency procedure for the management of large corneal perforations. It is a very useful method for Chinese hospitals where the shortage of cornea donors is a very serious problem and the amount of FS surgeries are increasing.

The analysis of the etiological factors and the treatment methods of exogenous endophthalmitis

Objective To investigate the etiological factors and treatment methods of exogenous endophthalmitis. Methods Data of all cases of infectious endophthalmitis treated between August 2006 and December 2013 were reviewed retrospectively and compared with our earlier published report.One hundred and sixteen eyes of 116 cases aged from 18 to 90 years with mean (48.16±15.56) years were enrolled, including 77 male and 39 female patients.95.69% cases accepted vitrectomy and intravitreal antibiotics injection. The follow-up period was from 1 to 12 months. Results Endophthalmitis was in 83 eyes(71.55%) caused by penetrating injury, in 24 eyes (20.69%) caused by cataract surgery, in 5 eyes (4.31%) caused by anti-glaucoma surgery, in 2 eyes (1.72%) caused by vitrectomy and in 2 eyes(1.72%)caused by corneal ulcer perforation. Compared with our earlier report. the percentage of Gram-positive cocci isolates increased which occurred in 48 eyes accounting for 87.27%, while the percentage of the Gram-positive bacilli isolates was 5.45% which occurred in 3eyes and the percentage of Gram-negative bacilli isolates was 7.27% which occurred in 4eyes, both of which decreased. After vitrectomy and intravitreal antibiotics injection, postoperative visual acuity were ≥0.02 in 91 eyes(78.45%)and ≥0.3 in 38 eyes(32.76%). Conclusion Penetrating ocular injury and cataract surgery are the most common causes of infective endophthalmitis. Staphylococcus epidermidis was the predominant pathogen. Combined vitrectomy and intravitreal antibiotics injection was an effective treatment for endophthalmitis. Key words: Etiologic factors; Endophthalmitis, exogenous; Ocular trauma, penetrating; Surgery, cataract extraction; Vitrectomy

A Case of Tectonic Lamellar Corneal Patch Graft Using Acellular Cornea in Corneal Ulcer Perforation

Purpose: We report a case of tectonic lamellar corneal patch graft using acellular corneal tissue (Halo Sterile Cornea; Lions VisionGift, Portland, OR, USA) for treating a large corneal ulcer perforation Case summary: A 72-year-old male previously treated for corneal ulcer was referred after presenting with decreased vision and abrupt tears in the right eye. His best-corrected visual acuity was 0.025 (20/800) and slit-lamp examination showed collapsed anterior chamber and 2 x 2 mm corneal perforation with protruded iris at the peripheral cornea. Infiltration in superficial stroma was observed near the perforation. Despite conjunctival flap, the cornea showed leakage due to perforation. To preserve ocular integrity, the patient underwent tectonic lamellar corneal patch graft using acellular corneal tissue. After surgery, the corneal patch graft was well attached. Re-epithelialization occurred after 3 days. There was no recurrence of perforation or corneal graft melting. Visual acuity improved to 0.32 (20/63) after 6 months. Conclusions: Tectonic lamellar corneal patch graft using acellular corneal tissue can be a useful treatment option in large corneal ulcer perforation located at the periphery. J Korean Ophthalmol Soc 2015;56(8):1278-1283

Role of Evacuation of Anterior Chamber Exudates as an Adjunct in the Management of Deep Fungal Keratitis

Aim: To assess the role of evacuation of anterior chamber exudates as an adjunct in management of deep fungal keratitis Methods: Retrospective interventional case series in which 23 patients with microbiologically proven fungal keratitis presenting with anterior chamber exudates or hypopyon who presented between January 2009 & June 2013 were chosen. Depth of the infiltrate scored from 1 to 3 based on depth of involvement and those with infiltrate depth score of 2 or 3 were included. Patients with perforated corneal ulcers, infectious keratitis co-existent with any other organism or endophthalmitis were excluded. Demographic/Clinical data was recorded. All patients underwent anterior chamber evacuation of exudates. Primary outcome measure was complete resolution of infection defined as resolution with scar formation without subsequent recurrence for 1 month. Outcome was 'failure' if patient needed therapeutic keratoplasty or evisceration. Secondary outcome measure was comparative sub-group analysis between patients who had successful or failed outcome (group 1/2). Results: Mean age was 55.21+13.7, Male: female was 15:8. Mean infiltrate size score was 2.43+0.5, mean infiltrate depth score was 2.6+0.5. Hypopyon and endoexudates were seen in 20(87%) and 15 (65.2%) cases. At mean duration of 39.7+46.8 days, 8(34.8%) patients had successful and 15(65.2%) patients had failure of outcome. Patients with failed outcome had larger (p=0.02) and deeper (p=0.008) corneal infiltrates. Outcome was established earlier in group 2. (p=0.0001)

Bilaterale vaskularisierte disziforme Hornhautnarbe herpetischer Genese bei einem Kind

Bilateral keratitis is rare and can have various causes. For a good outcome after treatment, the correct diagnosis is decisive. A 15-year-old boy presented to our clinic with recurrent keratoconjunctivitis and progressive loss of vision in both eyes since 6 years. The best corrected visual acuity was 0.1 in the right eye and 1/12 in the left eye. Slit-lamp examination verified keratitis disciformis with strongly vascularized corneal stromal scars without conjunctival follicles on both sides. Based on the clinical diagnosis, antiviral treatment was initiated. Best corrected visual acuity 8 weeks later increased to 0.4 in the right eye and 0.8 in the left eye and the corneal edema decreased in both eyes. Due to noncompliance the patient returned with a perforated corneal ulcer of the left eye, where an á chaud penetrating keratoplasty had to be performed. Herpes simplex virus is one of the most common causes of keratitis and has different manifestations. In the treatment of keratitis disciformis the use of topical steroids is mandatory as there is an active immunological process. The use of systemic and local antiviral treatment is necessary at the same time in order to avoid reactivation of viral replication. Bilateral keratitis is relatively frequent in children. Herpetic keratitis is now well treatable if the various manifestations of the disease are recognized early and an appropriate therapy is adjusted accordingly.