Corneal perforations. Changing methods of treatment, 1960--1980

One hundred four nontraumatic corneal perforations or descemetoceles in patients admitted to the Wilmer Institute from 1960 to 1980 were studied retrospectively, with follow-up data obtained from records or from referral physicians for 87 of these perforations. Forty-nine percent of the cases were caused by bacterial corneal ulcers, 13% by exposure, 12% by chemical burns, 6% by fungal keratitis, 5% by herpes simplex keratitis, and 15% were undiagnosed. Since the start of tissue adhesive use at the Wilmer Institute in 1974, there has been an apparent trend towards a lower enucleation rate (6%) in corneal perforations treated with tissue adhesive as compared to 19% in perforations treated by other therapies, although the cases may not be entirely comparable. An improved visual result of 20/200 or better was achieved in 29% of patients treated with tissue adhesive as compared to 19% with other treatment.