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

Abstract

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.

Tectonic Eccentric Penetrating Sclerokeratoplasty à chaud as Treatment for Peripheral Perforated or Predescemetal Corneal Ulceration

“…Other authors, e.g. Bialasiewicz and Naumann, Riedel et al, Jonas et al or Dogan and Arslan, have published reports on similar patients and surgeries 16 , 17 , 18 , 19 . On the whole, however, the patient cohorts and diagnoses on which these reports are based represent a mixed bag, whereby the reported operations also include eccentric mini-keratoplasties, “normal” perforated keratoplasties and tectonic keratoplasties.…”

Prognostic Factors Affecting Graft Survival in Patients Undergoing Penetrating Keratoplasty for Infectious Keratitis

“…In these cases, successful PKP eradicates infection and ensures preservation of anatomic integrity and function of the eye. 13 In the literature, anatomic success rates of 85.96% and 89.7% were reported by Raj et al 11 and Sharma et al 10 , therapeutic success rates of 89.47%, 89.7%, and 97.6% were reported by Raj et al 11 , Sharma et al 10 , and Doğan and Arslan 14 , respectively, and Raj et al 11 reported 70.17% functional success in patients who underwent PKP due to keratitis. In our series of patients who underwent therapeutic PKP due to infectious keratitis, we achieved 98.3% anatomic success, 79.7% therapeutic success, and 54.2% functional success.…”

“…Previous studies reported rates of graft transparency between 23% and 84.6%. 22 , 23 , 24 , 25 , 26 Doğan and Arslan 14 reported graft transparency rates of 83.3% at 1-year follow-up and 71% at 2-year follow-up, and noted that graft transparency was lower with grafts that were larger than 8 mm and those that were close to the limbus. In our study, the graft transparency rate was 52.5% after a mean follow-up of 30 months, and our results were in concordance with the literature.…”

“…In microbiological analysis of corneal samples from the patients in our study, bacteria were detected in 20 patients (33.90%), fungi in 12 patients (20.34%), and viral agents in 5 patients (8.47%), while no microorganisms were detected in culture or direct examination in 22 cases (37.29%). Doğan and Arslan 14 determined the causative factor to be bacterial in 69.7%, viral in 14%, fungal in 11.6%, and Acanthamoeba in 4.6% of keratitis patients who underwent PKP. Yılmaz et al 17 reported bacterial infection in 28.2% and fungal infection in 8.06% of keratitis cases followed in their clinic.…”

Therapeutic and Tectonic Keratoplasty with Simple Cryopreserved Remnants of Donor Corneas: An 11 Year Retrospective Case Series

“…If systemic immunosuppressants and antibiotics are used together, patients are at risk for severe nephrotoxicity and hepatotoxicity, especially in elderly cohorts 50,51 . Because the prevalence of infectious keratitis is relatively high in elderly and medically compromised patients, it would be inappropriate to use fresh cornea for therapeutic keratoplasty in these cases 52,53 . In fact, in the present study, the average age of patients who underwent therapeutic keratoplasty for infectious corneal ulcers was 70.9 years, and major medical conditions were present in most patients.…”