Therapeutic deep lamellar keratoplasty for corneal perforations

Corneal perforation can be potentially blinding unless the integrity of the globe is restored quickly. Although penetrating keratoplasty (PK) may achieve this, it carries a high risk of endothelial rejection in inflamed eyes. Deep lamellar keratoplasty (DLK) may be an alternative option to PK in such eyes owing to its potential for a lower incidence of rejection. We report the efficacy of DLK in patients with corneal perforations.

Four patients underwent layer-by-layer DLK for noninfective corneal perforation, after measures such as the use of a bandage contact lens, tissue adhesive, and conjunctival pedicle flap had failed. The preoperative visual acuity was hand movements in one patient, 1/60 in two, and 6/60 in one. All four had iris incarcerated within the corneal perforations. SF6 gas (three patients) and air (one patient) were injected into the anterior chamber at the end of surgery.

The integrity of the globe was restored in all four patients with an improvement in visual acuity (6/60 in one and 6/36 or better in three). The mean follow-up time was 7 months. All four patients had clear corneas 3 months postoperatively, apart from the area of the original perforation. There was no recurrence of ulceration or perforation.

DLK is a safe and effective therapeutic measure in the management of patients with corneal perforations acting to preserve the integrity of the globe and restore vision.