SURGICAL MANAGEMENT OF PERIPHERAL CORNEAL ULCERATIONS: LAMELLAR CRESCENT KERATOPLASTY OUTCOMES

Published 2024 - 28th ESCRS Winter Meeting

Reference: FP33 | Type: Submission | DOI: 10.82333/zw24-2j61

Authors: Catarina Barão* ¹ , Nuno Rodrigues Alves ¹ , Bruna Cunha ¹ , Sara Crisóstomo ¹ , Nuno Alves ¹ , Vítor Maduro ¹ , João Feijão ¹

¹Ophthalmology,Central Lisbon Universitary Hospital Centre,Lisbon,Portugal

Purpose

Anterior lamellar crescent keratoplasty (DALK) has emerged as the preferred surgical approach for peripheral corneal stromal disorders when the endothelium remains in a healthy state. The purpose of this presentation is to evaluate efficacy and safety of anterior lamellar crescent keratoplasty in patients with peripheral corneal ulcerations.

Setting

Central Lisbon Universitary Hospital Centre, Lisbon, Portugal

Methods

A retrospective clinical series of 12 patients (12 eyes) treated with a crescentic DALK for peripheral corneal ulcerations managed at Central Lisbon Universitary Hospital Centre, Lisbon, Portugal from January 2015 to January 2023 was collected. Pre-operative data collected included: age, sex, ulcer etiology and best corrected visual acuity (BCVA). Post-operative outcomes included: average BCVA at 12 months, corneal post surgery astigmatism at 3, 9 and 12 months and post surgical complications.

Results

The study included 12 eyes of 12 patients with a mean age of 52.58 ± 12.41 years. There were two eyes with ulcers caused by rheumatoid arthritis, three Mooren ulcers, four Terrien marginal degeneration ulcers, one pellucid marginal degeneration ulcer and two peripheral ulcers caused by Herpes Simplex Virus (HSV) keratitis. Prior to the surgical procedure, the BCVA among the patients was 20/100. Following the surgical intervention, there was a notable improvement in visual acuity, with the average BCVA increasing to 20/40. Excluding two cases of recurrence of disease, BCVA improved in all other patients. Regarding post surgery astigmatism, our patients had 6.0D+- 1.5D at 3 months, 3.0D+- 1.9D at 9 months and 2.9D+-1.8D at 12 months. Post surgery complications included cataract formation in two patients and elevation in intraocular pressure (IOP) in two patients.

Conclusion

Surgical treatment of peripheral corneal ulcers is often difficult, challenging and time consuming. However, crescent grafts were associated with a good visual acuity recovery which is attributed to the avoidance of straddling of the visual axis by the presence of sutures. Despite progress in surgical technique, corneal astigmatism remains one of the leading causes of limited visual recovery. In our study, after corneal suture removal our patients had a resulting low/medium astigmatism, that could be managed with spectacles. So, performing crescentic anterior lamellar keratoplasty for peripheral corneal ulcers is an safe and effective surgical option in the treatment of these patients.