Eye preservation tectonic graft using glycerol-preserved donor cornea

Abstract

Aims: To report the surgical outcome of tectonic graft using glycerol-preserved donor corneas to treat perforated keratitis.

Methods: The medical records were reviewed of all patients treated for perforated keratitis using glycerol-preserved corneas at a single institution between 1 July 2004 and 31 June 2010. The clinical features, precipitating factors, adjuvant therapies, and therapeutic outcomes were analyzed. Success was defined as re-epithelialization of the ocular surface without evisceration.

Results: Fourteen eyes from 14 patients (6 male and 8 female) were included. Age ranged from 58 to 84 years (average, 70.71 ± 8.52 years) and the follow-up time ranged from 7 to 56 months (mean, 25.35 ± 16.84 months). The culture results showed five bacterial infections, five cases of fungal keratitis, and one mixed infection; the culture results were negative for three patients. Satisfactory anatomical integrity was obtained in eight grafts (57.14%) that healed with neovascularization. Six grafts (48.85%) showed delayed re-epithelialization and were repaired with conjunctival flaps to maintain ocular surface integrity. Three patients developed secondary glaucoma and received trans-scleral cyclophotocoagulation. Thirteen patients had satisfactory anatomical integrity without evisceration or exenteration, while one patient received evisceration at 39-month follow-up because of intractable glaucoma.

Conclusions: Glycerol-preserved donor corneas combined with anterior vitrectomy with or without conjunctival flaps may be effective substitutes for evisceration surgery in patients with perforated keratitis.

Figure 1

Fusarium keratitis with imminent perforation despite previous amniotic membrane transplantation. (a) Anterior chamber exudation is evident. (b) Ocular surface integrity maintained at day 12 after glycerol-preserved cornea patch graft. (c) At eight months follow-up, the cornea healed, showing opacity and neovascularization.

Figure 2

Acremonium keratitis perforation with iris protrusion. (a) Iris protrusion evident. (b) Patch graft re-epithelialized at 2 weeks postoperative follow-up. High intraocular pressure was managed with trans-scleral cyclophotocoagulation. (c) Graft neovascularization was evident at three months postoperative follow-up.