Abstract

Volume.123 Number.2

Original article : Clinical science

Postoperative Course Following Therapeutic Lamellar Keratoplasty for Peripheral Corneal Perforation
Yuko Kawamura1, Junko Yoshida1, Rika Shirakawa1, Tetsuya Toyono1, Takashi Miyai1, Satoru Yamagami2, Tomohiko Usui2
1 Department of Ophthalmology, The University of Tokyo School of Medicine
2 Department of Ophthalmology and Visual Science, Nihon University School of Medicine
3 Department of Ophthalmology, International University of Health and Welfare

Purpose: The aim of this study was to investigate the postoperative course for patients who underwent lamellar keratoplasty (LKP) for peripheral corneal perforation.
Subjects and methods: The study included 17 eyes of 17 patients (9 eyes of 9 males and 8 eyes of 8 females) who underwent LKP for peripheral corneal perforation at the University of Tokyo Hospital between June 2004 and September 2016. We retrospectively investigated the causative disease, number of surgical procedures, period until re-perforation, whether final closure of the perforation occurred, graft type, size and shape of graft, changes in visual acuity before and after surgery (visual acuity after perforation but before surgery and visual acuity at one month postoperatively), changes in visual acuity in patients who underwent multiple surgical procedures, and whether oral medications were administered.
Results: Out of the 17 patients, the most common causative disease was Mooren's ulcer (7 patients; 41.2%), followed by collagen disease-related corneal ulcer (3 patients; 17.6%). The period until re-perforation following LKP was within 6 months in 8 of the 13 cases (61.5%). Final perforation closure was achieved during the observation period in 16 patients of the 17 patients (94.1%). The examination of postoperative visual acuity changes for each procedure revealed improvement in 10 (45%), exacerbation in 5 (23%), and no change in 7 (32%) cases. Conversely, comparison of visual acuity changes before the initial surgery and after performing multiple procedures in patients who underwent multiple surgeries revealed that improvement was achieved in 1 (17%), exacerbation occurred in 3 (50%), and no change was observed in 2 (33%) patients. The postoperative systemic administration of steroids and immunosuppressants were useful in stabilizing the patients'condition.
Conclusions: Auto-immune ulcers are common causes of peripheral corneal perforation. Careful postoperative management, including the systemic administration of steroids and immunosuppressants, and attention to early postoperative re-perforation is necessary in such patients.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 123: 143-149, 2019.

Key words
Peripheral corneal perforation, Lamellar keratoplasty (LKP), Mooren's ulcer, Collagen disease-related corneal ulcer, Immunosuppressants
Reprint requests to
Junko Yoshida, M.D., Ph.D. Department of Ophthalmology, The University of Tokyo School of Medicine. 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan