Therapeutic keratoplasty for corneal perfuration: 3 years of cases in a tertiary referral hospital
First Author: R.Serras-Pereira PORTUGAL
Co Author(s): D. Hipólito-Fernandes M. Luís S. Crisóstomo J. Feijão N. Alves V. Maduro
Corneal perforation is one of the most vision threatening corneal diseases. Perforated eyes require immediate treatment to restore anatomic integrity and avoid complications. The aim of our study was to describe the outcomes of tectonic keratoplasty (full-thickness penetrating keratoplasty or anterior lamellar keratoplasty) to treat corneal perforations over a 3-year period.
Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
Retrospective study which included thirty-five eyes of 35 patients (23 males and 13 females; mean age of 61.43 ± 17.31 years) who underwent therapeutic keratoplasty for corneal perforation, with a minimum follow-up time of 12 months. Corneal perforation causes, surgical procedure, complications, functional and anatomic outcomes were evaluated.
The main cause of perforation were bacterial ulcer (n=12), followed by herpetic keratitis (n=9), Stevens-Johnson syndrome (n=2) and chemical burn (n=2). Penetrating keratoplasty was performed in 31 eyes (88.6%) and anterior lamellar keratoplasty in 4 eyes (11.4%). Eighteen patients (51.4%) had history of previous corneal transplantation. Visual acuity improved or didn’t change in thirty eyes (85,7%). Thirty-one of the eyes (88,6%) achieved anatomic cure and further keratoplasty was necessary in seven. At the last visit, graft transparency was achieved in 29 eyes (82,3%). The most frequent complications were glaucoma (n=6), followed by persistent epithelial defect (n=5) and cataract (n=3).
Corneal transplantation, including both penetrating and anterior lamellar keratoplasty proved to be good technique for corneal perforations, allowing favourable anatomical results. In these cases, postoperative visual acuity improvement is much more limited comparing to elective keratoplasties. Despite this fact, we may consider our visual results as satisfactory.