EEBA Program (PDF/3MB) - EEBA - Annual Meeting

MANAGEMENT IN NON-TRAUMATIC CORNEAL PERFORATIONSB. Rymgałło-Jankowska¹, A. Bielińska¹, E. Rakowska¹, D. Haszcz¹, G. Płaszczewska², M. Skowronek²¹Department of Ophthalmology, Lublin; ²Eye Bank Lublin, PolandMaterials: In January 2010-July 2012 twenty-two patients with non-traumatic corneal perforations ordescemetocoele were admitted to our department. Dry eye syndrome in patients with rheumatoidarthritis was diagnosed in 10 cases. Bacterial (8) and viral (4) ulcer was diagnosed in 10 cases.Methods: Non-surgical steps included: corneal and conjunctival microbiological culture, topicalmedications: antibiotics (fluoroquinolones), atropine, artificial tears, ointment with vitamin A, contactlens application, lacrimal silicone plugs implantation. Surgical procedures: Amniotic membranetransplantation covering the whole surface of the cornea by amniotic membrane, placing amnioticmembrane in previously performed corneal pocket in the anterior part of the cornea. Keratoplastyfull-thickness graft (7-8 mm diameter of trephination), full-thickness mini-graft (4-5 mm), anteriorgraft, posterior mini-graft. Tectonic graft (epi-keratoplasty) covering with full-thickness corneo-scleralgraft. Blepharorraphy as a procedure supporting corneal healing kantorrhaphy or blepharorrhaphy,temporary or permanent.Results: In 21 cases corneal perforation was successfully healed. In 10 patients visual acuity improved.In 8 cases during two-years follow-up additional surgical treatment was needed, including tectoniccorneo-scleral graft in two patients, keratoplasty with full-thickness graft after previous amnioticmembranetreatment and exchanging corneal button in two patients. In one case, treated nonsurgically,mini-keratoplasty was performed due to progressive corneal melting that occurred in6 months after initial treatment. In one patient enucleation was performed due to severe cornealmelting and loss of light perception.Conclusions: Non-traumatic perforations or severe descemetocoele diagnosed in many anteriorsegment pathologies might lead to the loss of the eyeball if untreated. Topical treatment, contactlens application and tissue glue are among non-surgical therapeutic options. In progressive cornealmelting resistant to that kind of therapy application of amniotic membrane, keratoplasty, tectoniccorneo-scleral graft or blepharorrhaphy are possible treatment procedures. Choosing appropriatemethod depends on surgeon’s experience and tissue availability in the Eye Bank. Long-term andcomplex treatment is needed concerning general disorders that might have influence on cornealperforation.XXV ANNUAL MEETING OF THE EUROPEAN EYE BANK ASSOCIATION Zagreb, Croatia 18/19 January 2013 61