Outcomes of Penetrating and Lamellar Corneal Patch Grafts

To report the indications, long-term structural and functional outcomes, and prognostic factors for the success of penetrating and lamellar corneal patch grafts.

This is a retrospective analysis of 49 patients who underwent the corneal patch graft procedure over 8 years. The baseline, preoperative, and postoperative characteristics along with their outcomes were evaluated.

Forty-nine eyes (49 patients) with a mean follow-up of 20.3 ± 3.27 months (range 6-48) were included. Thirty-one patients underwent full-thickness grafts for corneal perforation, and 18 underwent lamellar grafts for severe thinning. The most common indication was corneal thinning and/or perforation secondary to microbial keratitis (17 eyes, 34.7%). Anatomic success was achieved in 31 eyes (63.2%), in which no further surgical intervention was required for tectonicity. Functional success was achieved in 22 of 37 eyes (59.5%), where along with anatomic success, significant visual gain was also obtained. Absolute graft failure was noted in 12 eyes (24.5%), which developed recurrence of primary pathology requiring reintervention within the first 6 months. Good prognostic factor for success included sterile corneal perforations. The presence of microbial keratitis was noted to be a guarded prognostic factor for success.

Corneal patch graft can serve as a good therapeutic modality for corneal ulceration or thinning, not amenable to treatment with tissue adhesive application. Both anatomical success and functional success of 60% was achieved in our series. Those performed for immune-mediated conditions fared the best. Subsequent optical procedures may be performed for further visual rehabilitation at a later stage.