title: Nonmechanical excimer laser penetrating keratoplasty for perforated or predescemetal corneal ulcers.
abstract: OBJECTIVE
  To review the authors' results using nonmechanical excimer laser trephination in penetrating keratoplasty for perforated or predescemetal corneal ulcers.
  
  
  METHODS
  Noncomparative, consecutive, interventional case series.
  
  
  METHODS
  Thirty-two patients with perforated (17) or deep (15) corneal ulcers (9 bacterial, 5 acanthamoebal, 10 herpetic, 3 associated with rheumatoid arthritis, 5 other) necessitating immediate tectonic keratoplasty.
  
  
  METHODS
  Penetrating tectonic keratoplasty with excimer laser trephination was performed along metal aperture masks in donor and recipient corneas.
  
  
  METHODS
  Clinical results including intraoperative and postoperative complications were evaluated.
  
  
  RESULTS
  Trephination was possible in all eyes without perforation of predescemetal ulcers or extrusion of intraocular contents. No eyes with bacterial or acanthamoebal ulcers showed persistence or recurrence of infection. One eye showed recurrent epithelial herpetic keratitis. Best-corrected postoperative visual acuity ranged from 20/700 to 20/20 (median, 20/58), with 30 of 32 eyes achieving improvement of best visual acuity during follow-up (mean, 22.4 months) and with 12 of 32 eyes reaching a visual acuity of 20/40 or greater. Eyes with bacterial or acanthamoebal ulcers showed best results. Episodes of graft rejection occurred in nine eyes and resulted in irreversible opacity of the graft in seven cases. None of the eyes lost all vision, developed endophthalmitis, or had to be enucleated.
  
  
  CONCLUSIONS
  Nonmechanical trephination is a useful technical refinement of tectonic penetrating keratoplasty à chaud for perforated or deep progressive corneal ulcers. This technique greatly facilitates exact trephination under these difficult surgical conditions and might possibly improve the prognosis of this procedure.
authors.affiliation: Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany. micheal.kuechle@augen.med.uni-erlangen.de
authors.forename: M
authors.initials: M
authors.lastname: Küchle
authors.forename: B
authors.initials: B
authors.lastname: Seitz
authors.forename: A
authors.initials: A
authors.lastname: Langenbucher
authors.forename: G O
authors.initials: GO
authors.lastname: Naumann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000601:surgery*; D003320:Corneal Ulcer / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012422:Rupture, Spontaneous; D014792:Visual Acuity