TECTONIC KERATOPLASTY VERSUS CROSS LINKING IN RESISTANT CORNEAL ABSCESS

to compare the results of using tectonic keratoplasty versus using  cross linking in resistant corneal abscess 

memorial institute for ophthalmic research

Prospective interventional comparitive study of (20) eyes of 20 patients ( 10 in each group) (15males and 5 female) aged between 20-53 years with unilateral corneal abscess .Patients were done by 1 surgeon in the memorial institute for ophthamic research (MIOR) with follow up period ranges from 6 m -1years.Inclusion Criteria : patients with unilateral corneal abscess, resistant to medical treatment ,any causative organism .Excluison Criteria : corneal abscess respond to medical treatment .Surgical Technique :  tectonic keratoplasty was done as original pkp with some precautions as to take all the abscess in the trefined area leaving edges free of infection , wash the anterior segment with antibiotics, use interrupted sutures . and in cross linking , 1st scrap the cornea to remove the residual epithelium and dead tissue then soaking the cornea for 20 min. then use ultraviolet (Avedro) in the pulsed mode for 6 mins  .PreOperative :full ophthalmic examination spiecally size and depth of abscess and infilteration, level of hypopyon, ultrasound to assess posterior segment involvment  .post operative:  signs of improvement as corneal vascularization, decrease the infilteration and size of abscess , decrease level of hypopyon .

90% of eyes treated with cross linking showed marked improvment within few days , only one eye  showed resistant to cross linking and need keratoplasty . while only 70% of eyes treated with tectonic keratoplasty improved and 30% ( 3 eyes)showed reinfection within 1 week with more aggressive course ,  these 3  eyes were treated after reinfection with cross linking , 2 of them respond to crosslinking and last 1 need regrafting again .

using both tectinic keratoplasty or cross linking give good resuits  to treat corneal abscess but  there is high incidence of reinfection (failure) with tectonic keratoplasty than with crosslinking which  shows excellent results.

so, the use of crosslinking in resistant corneal abscess is more easy and more safe technique and give better results than keratoplasty and also the donot loss the chance to do tectonic keratoplasty if cross linking failed