[Tectonic epikeratoplasty as an alternative to keratoplasty à chaud?]

To compare the outcome of epikeratoplasty vs. penetrating keratoplasty in patients with corneal ulcer.

24 patients had been treated by an epikeratoplasty and 20 patients by a penetrating keratoplasty within 5 years. The indication to operate was progression of a corneal ulcer, perforated ulcer or a descemetocele. In epikeratoplasty a complete cornea with adjacent scleral rim was fixed upon the recipient eye by scleral sutures. This transplant was removed after some weeks. In both groups the patients were reexamined and the anatomical and functional outcome was registered.

In both groups all but one globe could be saved. The integrity of corneal surface was restored in 85% (n = 17) of the keratoplasty group and in 75% (n = 18) in epikeratoplasty. The vascularization of the cornea after removing the transplant in epikeratoplasty patients was increased by 70% (n = 17) and their corneas revealed more opacification than before. In the penetrating keratoplasty patient group the vascularization increased in 40% (n = 8) and in 20% (n = 4) of the patients the transplant became cloudy. The visual acuity improved in 13 cases in penetrating keratoplasty but only in two cases after epikeratoplasty.

A corneal ulcer (with or without perforation) treated by a penetrating keratoplasty with removing the ulcerated tissue has a better outcome than an ulcer covered by an epikeratoplasty. In patients only able to tolerate a short time of surgery with minimal operative risk or if there is no possibility of microsurgical treatment epikeratoplasty may be an alternative to penetrating keratoplasty in saving the globe. However, in most patients penetrating keratoplasty has better functional results.