Tectonic lamellar patch graft
Ashok Sharma, Rajan SharmaPurpose:
Large corneal perforations often require tectonic grafts or full-thickness penetrating keratoplasty (PKP). Deep anterior lamellar keratoplasty (DALK) may be a safe and effective alternative to PKP in such cases with a lower long-term rejection rate. This study aims to evaluate the efficacy and safety of DALK as an alternative to PKP in the management of large corneal perforations.
Methods:
This retrospective, interventional case series included 41 consecutive patients (41 eyes) who underwent DALK for corneal perforations >3.0 mm. All cases included were refractory to medical treatment, glue application, or amniotic membrane application. The data on etiology, size of perforation, complications, and outcomes were retrieved and analyzed. The surgical procedure consisted of ab externo dissection (layer-by-layer dissection from the epithelial side), ab externo and ab interno dissection (layered external dissection plus Descemet’s membrane separation), and zero excision (no excision of corneal stroma to fit donor lenticule) with customized donor lenticules (obtained desired shape and sized lenticule using trephines and avoided manual dissection).
Results:
The majority (60.7%) of the population was male, with a mean age of 53.07 ± 17.51 years. Etiology included Mooren’s ulcer 11 (27%), post-bacterial 9 (22%), postfungal 4 (10%), postherpetic 3 (7%), posttraumatic 6 (15%), neurotrophic 5 (12%), and dry eye 3 (7%). Twenty four patients (58%) had central corneal perforations and 17 (42%) had peripheral corneal perforations. Twenty-nine (70%) eyes underwent ab externo corneal stromal dissection, 7 (17%) combined ab eterno and ab interno corneal stromal dissection, and 5 (13%) zero dissection with customized donor lenticule. Of 41 corneal perforations, 36 (88%) healed successfully. Five eyes needed PKP due to recurrence of fungal infection (3), recurrence of herpes simplex infection (1), and corneal ulceration in dry eye (1).
Conclusions:
As an alternative to PKP, DALK can be a successful surgical method to treat large corneal perforations.