Therapeutic deep lamellar keratoplasty for corneal perforations.

Objectives/aims: Corneal perforation can be potentially blinding unless the integrity of the globe is restored quickly. Although penetrating keratoplasty (PK) may achieve this, it carries a high risk of endothelial rejection in inflamed eyes. Deep lamellar keratoplasty (DLK) may be an alternative option to PK in such eyes owing to its potential for a lower incidence of rejection. We report the efficacy of DLK in patients with corneal perforations.
Patients and Methods: Four patients underwent layer-by-layer DLK for noninfective corneal perforation, after measures such as the use of a bandage contact lens, tissue adhesive, and conjunctival pedicle flap had failed. The preoperative visual acuity was hand movements in one patient, 1/60 in two, and 6/60 in one. All four had iris incarcerated within the corneal perforations. SF6 gas (three patients) and air (one patient) were injected into the anterior chamber at the end of surgery.
Results: The integrity of the globe was restored in all four patients with an improvement in visual acuity (6/60 in one and 6/36 or better in three). The mean follow-up time was 7 months. All four patients had clear corneas 3 months postoperatively, apart from the area of the original perforation. There was no recurrence of ulceration or perforation.
Conclusion: DLK is a safe and effective therapeutic measure in the management of patients with corneal perforations acting to preserve the integrity of the globe and restore vision.