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Impressum
Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or predescemetal corneal ulcers
1,2Jonas J. B., 1Rank R. M., 1Budde W. M.
Department of Ophthalmology and Eye Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Germany1; Department of Ophthalmology and Eye Hospital, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Germany2 Corresponding author: Dr. J. Jonas, Universitäts-Augenklinik, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; Phone: **49-621-383-2242; Fax: **49-621-383- 3803; e-mail: Jost.Jonas@ma.augen.uni-heidelberg.de
Purpose: To report the clinical outcome of patients with perforated
or predescemetal corneal ulcers treated by tectonic, centric or eccentric,
penetrating keratoplasty or by tectonic sclerokeratoplasty.
Methods: The nonrandomized clinical trial included 60 patients
(60 eyes) with perforated or predescemetal corneal ulcers who were consecutively
operated on by the same surgeon. Fifty-two patients underwent tectonic
penetrating, centric or eccentric, keratoplasty. Eight patients with paralimbal
corneal ulcers underwent tectonic sclerokeratoplasty. A control group
consisted of 76 patients (76 eyes) electively undergoing central penetrating
keratoplasty for treatment of inactive central corneal scars.
Results: In the study group with perforated or predescemetal corneal
ulcers, bestcorrected postoperative visual acuity ranged from perception
of light to 0.80 (median, 0.10), with 54 of 60 (54/60=90%) eyes achieving
an improvement of best visual acuity. In 10 patients (10/60=16.7%), tectonic
penetrating keratoplasty had to be re-performed due to a recurring corneal
ulcer. Patients with sclerokeratoplasty and patients with eccentric keratoplasty
did not differ in clinical outcome despite larger trephine and corneal
lesion size in the sclerokeratoplasty group. Among study patients compared
with control patients, postoperative visual acuity was significantly (p=0.01)
lower, postoperative refractive and keratometric astigmatism were significantly
(p<0.05) higher, and immunologic graft reactions (P=0.02) and suture
loosening (P<0.001) occurred significantly more often.
Conclusions: Eyes with perforated corneal ulcers or predescemetal
corneal ulcers can usually be saved by tectonic keratoplasty or sclerokeratoplasty,
with a moderate to considerable amount of remaining useful vision. In
case of doubt, one may prefer conservative treatment of corneal ulcers
and to electively perform central keratoplasty when the ulcers have healed.
For selected clinical situations, sclerokeratoplasty is an alternative
to keratoplasty for surgical treatment of paralimbal corneal defects.