Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or predescemetal corneal ulcers

PURPOSE: To report the clinical outcome of patients with perforated or pred escemetal corneal ulcers treated by tectonic, centric or eccentric penetrat ing keratoplasty or by tectonic sclerokeratoplasty. DESIGN: Nonrandomized clinical trial. METHODS: The study included 60 patients (60 eyes) with perforated or predes cemetal corneal ulcers who were consecutively operated on by the same surge on. Fifty-two patients underwent tectonic penetrating centric or eccentric keratoplasty. Eight patients with paralimbal corneal ulcers underwent tecto nic sclerokeratoplasty. A control group consisted of 76 patients (76 eyes) electively undergoing central penetrating keratoplasty for treatment of ina ctive central corneal scars. RESULTS: In the study group with perforated or predescemetal. corneal ulcer s, best-corrected postoperative visual acuity ranged from perception of lig ht to 0.80 (median, 0.10), with 54 of 60 eyes (90%) attaining an improvemen t of best visual acuity. In 10 of 60 patients (16.7-%), tectonic penetratin g keratoplasty had to be re-performed because of a recurring corneal ulcer. Patients with sclerokeratoplasty and patients with eccentric keratoplasty did not differ in clinical outcome, despite larger trephine and corneal les ion size in the sclerokeratoplasty group. Among study patients compared wit h control patients, postoperative visual acuity was significantly lower (P = .01), postoperative refractive and keratometric astigmatism were signific antly higher (P < .05), and immunologic graft reactions (P = .02) and sutur e loosening (P < .001) occurred significantly more often. CONCLUSIONS: Eyes with perforated corneal ulcers or predescemetal corneal u lcers 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 e lectively perform central keratoplasty when the ulcers have healed. For sel ected clinical situations, sclerokeratoplasty is an alternative to keratopl asty for surgical treatment of paralimbal corneal defects. (Am J Ophthalmol 2001;13 2:14-18. (C) 2001 by Elsevier Science Inc. All-rights reserved).