Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital

Abstract

PurposeTo report surgical therapies for corneal perforations in a tertiary referral hospital.MethodsThirty-one eyes of 31 patients (aged 62.4±18.3 years) with surgically treated corneal perforations from January 2002 to July 2013 were included in this study. Demographic data such as cause of corneal perforation, surgical procedures, and visual outcomes were retrospectively analyzed.ResultsThe causes of corneal perforation (n=31) were divided into infectious (n=8, 26%) and noninfectious (n=23, 74%) categories. Infectious causes included fungal ulcer, herpetic stromal necrotizing keratitis, and bacterial ulcer. The causes of noninfectious keratopathy included corneal melting after removal of a metal foreign body, severe dry eye, lagophthalmos, canaliculitis, the oral anticancer drug S-1, keratoconus, rheumatoid arthritis, neurotrophic ulcer, atopic keratoconjunctivitis, and unknown causes. Initial surgical procedures included central large corneal graft (n=17), small corneal graft (n=7), and amniotic membrane transplantation (n=7). In two cases the perforation could not be sealed during the first surgical treatment and required subsequent procedures. All infectious keratitis required central large penetrating keratoplasty to obtain anatomical cure. In contrast, several surgical options were used for the treatment of noninfectious keratitis. After surgical treatment, anatomical cure was obtained in all cases. Mean postoperative best corrected visual acuity was better at 6 months (logMAR 1.3) than preoperatively (logMAR 1.8).ConclusionSurgical therapies for corneal perforations in our hospital included central large lamellar/penetrating keratoplasty, small peripheral patch graft, and amniotic membrane transplantation. All treatments were effective. Corneal perforation due to the oral anticancer drug S-1 is newly reported.

Non-traumatic corneal perforations: aetiology, treatment and outcomes

“…Despite other studies that have evaluated aetiologies or treatment in corneal perforations, our study extensively describes the causes, surgical therapies and outcomes in this scenario 1 4…”

“…When the corneal perforation is larger in size, involving the corneal periphery, the treatment options are limited to tectonic grafts, where the corneal and/or scleral surfaces need to be restored 2 4 19 20. Hanada et al 12 reported that keratoplasty is a valuable option for maintaining ocular integrity and visual acuity.…”

“…There are a variety of approaches to treat these perforations, including non-surgical procedures like bandage soft contact lenses and tissue glues such as cyanoacrylate patch, and surgical treatments like multilayered amniotic membrane transplantation (AMT), conjunctival flaps and tectonic penetrating keratoplasty (PK) 4. Treatment depends on the aetiology, size and location of the perforation as well as the underlying disease status 4. The aim of this study is to report aetiology, clinical characteristics, treatment and outcomes of non-traumatic corneal perforations in a single referral centre.…”

Alternatives to eye bank native tissue for corneal stromal replacement

“…In these neurotrophic eyes, graft survival becomes problematic, and the same is expected for the implantation of biosynthetic corneal substitutes. (Bonini et al, 2003;Yokogawa et al, 2014).…”

The Placenta as an Organ and a Source of Stem Cells and Extracellular Matrix: A Review

“…Placentas and fetal membranes have been successfully used for tissue engineering applications. For instance, amniotic membrane has been used to prevent adhesions [Kuriu et al, 2009;Petter-Puchner et al, 2011;Ellington and Ferguson, 2014], to repair recto-vaginal fistulas [Roshanravan et al, 2014], to treat skin burns and wounds [Taghiabadi et al, 2015] and chronic leg ulcers [Zelen et al, 2013], and for regeneration of corneal and conjunctival epithelium [Yokogawa et al, 2014;Zeng et al, 2014;Zhou et al, 2015], although it was ineffective for treatment of Mooren's ulcer, a rare but severe ulcerative keratitis [Schallenberg et al, 2013]. In addition, its anticancer properties have been noted, probably due to the downregulation of HSP90 (heat shock protein 90), cancer cell cycle arrest and inhibition of angiogenesis [Magatti et al, 2012;Niknejad and Yazdanpanah, 2014].…”