Effect of Tectonic Penetrating Keratoplasty for Impending Perforation Due to Infectious Corneal Ulcer

PURPOSE: To investigate the effect of tectonic penetrating keratoplasty for the treatment of impending perforations caused by infectious corneal ulcers. METHODS: We analyzed preoperative and postoperative visual acuity, lesion location and size, graft size, postoperative outcome, and complications in 19 patients (19 eyes) with impending perforations due to infectious corneal ulcers. All patients underwent tectonic penetrating keratoplasty and had a minimum follow-up period of 6 months. RESULTS: In our study, eight eyes (42.1%) had herpes simplex keratitis, 6 eyes (31.6%) had bacterial keratitis, and 5 eyes (26.3%) had fungal keratitis. Twelve eyes had a lesion located in the central cornea, while 7 eyes had a lesion located in the paracentral cornea. Visual acuity improved in 13 eyes (68.4%) and anatomical success was achieved in 16 eyes (84.2%). Three eyes (15.8%) developed a graft melting secondary to rejection. Complications included bullous keratopathy (3 eyes, 15.8%), graft infection (3 eyes, 15.8%), neovascularization (2 eyes, 10.5%), and secondary glaucoma (1 eye, 5.3%). CONCLUSIONS: Tectonic penetrating keratoplasty maintains ocular integrity and effectively treats impending perforations caused by infectious corneal ulcers.

The Results of Cyanoacrylate Glue Application for Corneal Perforation and Impending Perforation

PURPOSE: To investigate the effectiveness of cyanoacrylate glue application in cases of corneal perforation or impending perforation due to refractory keratitis. METHODS: Cyanoacrylate glue was applied on 6 cases of fungal keratitis, 3 cases of herpetic keratitis, and 3 cases of bacterial keratitis from July 1998 to June 2002. 2 cases were corneal perforations and 10 were impending perforations. Cyanoacrylate glue was applied on stromal melting area including normal epithelium. When fibrovascular tissue grew beneath the glue sufficiently, glue was removed. When glue was sloughed off spontaneously or fibrovascular tissue was found to be insufficient, glue was reapplied. RESULTS: After average follow up of 25 weeks, the corneal surface was stabilized in 11 eyes except 1 case of fungal keratitis that had broad area of stromal melting(5.4mm). After use of glue, process of stromal melting was found to be discontinued. As fibrovascular tissue grew up beneath the glue, corneal surface became stable. Average diameter of stromal melting area and of glue application area was 4.0mm and 4.4mm respectively. Average duration of glue application was 17 weeks. CONCLUSIONS: Cyanoacrylate glue application appears to be an effective and convenient method in cases of corneal perforations and impending perforations associated with advanced and extensive fungal, bacterial, and herpetic keratitis with active keratolysis.