Tectonic clerokeratoplaty and tectonic penetrating keratoplaty a treatment for perforated or predecemetal corneal ulcer

PURPOE: To report the clinical outcome of patient with perforated or predecemetal corneal ulcer treated by tectonic, centric or eccentric penetrating keratoplaty or by tectonic clerokeratoplaty. DEIGN: Nonrandomized clinical trial. METHOD: The tudy included 60 patient (60 eye) with perforated or predecemetal corneal ulcer who were conecutively operated on by the ame urgeon. Fifty-two patient underwent tectonic penetrating centric or eccentric keratoplaty. Eight patient with paralimbal corneal ulcer underwent tectonic clerokeratoplaty. A control group conited of 76 patient (76 eye) electively undergoing central penetrating keratoplaty for treatment of inactive central corneal car. REULT: In the tudy group with perforated or predecemetal corneal ulcer, bet-corrected potoperative viual acuity ranged from perception of light to 0.80 (median, 0.10), with 54 of 60 eye (90%) attaining an improvement of bet viual acuity. In 10 of 60 patient (16.7%), tectonic penetrating keratoplaty had to be re-performed becaue of a recurring corneal ulcer. Patient with clerokeratoplaty and patient with eccentric keratoplaty did not differ in clinical outcome, depite larger trephine and corneal leion ize in the clerokeratoplaty group. Among tudy patient compared with control patient, potoperative viual acuity wa ignificantly lower (P = .01), potoperative refractive and keratometric atigmatim were ignificantly higher (P < .05), and immunologic graft reaction (P = .02) and uture looening (P < .001) occurred ignificantly more often. CONCLUION: Eye with perforated corneal ulcer or predecemetal corneal ulcer can uually be aved by tectonic keratoplaty or clerokeratoplaty, with a moderate to coniderable amount of remaining ueful viion. In cae of doubt, one may prefer conervative treatment of corneal ulcer and to electively perform central keratoplaty when the ulcer have healed. For elected clinical ituation, clerokeratoplaty i an alternative to keratoplaty for urgical treatment of paralimbal corneal defect.