[Autologous ipsilateral lamellar corneal-flap transposition for treatment of peripheral corneal perforation]

To study the clinical outcome of autologous ipsilateral lamellar corneal-flap transposition for treatment of peripheral corneal perforation.

Medical records of 13 patients who underwent autologous ipsilateral lamellar corneal-flap transposition for peripheral corneal perforation from January 2008 to February 2015 were retrospectively reviewed. The diameter of the corneal ulcers was all ≤ 3.0 mm, and the diameter of perforations was all ≤ 2.0 mm. All patients were followed up for 3-12 months with an average of 8 months. The healing of ulcer, clarity of the grafts, pre-and postoperative visual acuity, and astigmatism were documented and analyzed.

At 1 day after surgery, all patients had normal anterior chamber depth without aqueous leak. No double chamber or iris synechia was found. The corneal grafts showed mild to moderate edema. On postoperative days 7-14, the corneal edema receded, the grafts became transparent gradually, and the ulcer margin was blurred. Three months after surgery, all the grafts remained transparent. There was no recurrence of ulcer during the follow-up period. The best corrected visual acuity before and after surgery was 0.44 ± 0.19 and 0.47 ± 0.20, respectively, which indicated no statistically significant difference(t=0.706, P=0.461). The corneal astigmatism before and after surgery was 0.44±0.19 and 0.47±0.20, respectively, which showed statistically significant difference(t=2.391, P<0.05).

Autologous ipsilateral lamellar corneal-flap transposition is a safe and effective surgical procedure for treating peripheral corneal perforation. It can be considered as an alternative method for penetrating or lamellar keratoplaty when the availability of corneal tissue is limited, or for cases with a high risk of developing immunologic allograft rejection, although the surgical indications are limited. (Chin J Ophthalmol, 2016, 52: 663-668).