title: Modified tectonic keratoplasty with minimal corneal graft for corneal perforation in severe Stevens--Johnson syndrome: a case series study.
abstract: BACKGROUND
  Corneal perforation in severe Stevens-Johnson syndrome (SJS) presenting great therapeutic difficulties, the imperative corneal transplantation always result in graft failure and repeated recurrence of perforation. The aim of this study was to evaluate the effectiveness of a modified small tectonic keratoplasty (MSTK) with minimal corneal graft in the management of refractory corneal perforation in severe SJS.
  
  
  METHODS
  Refractory corneal perforations in ten patients (10 eyes) with severe SJS were mended with a minimal corneal patch graft, under the guidance of anterior chamber optical coherence tomography, combined with conjunctival flap covering. The outcome measures included healing of the corneal perforation, survival of the corneal graft and conjunctival flap, relevant complications, and improvement in visual acuity.
  
  
  RESULTS
  Corneal perforation healed, and global integrity was achieved in all eyes. No immune rejection or graft melting was detected. Retraction of conjunctival flap occurred in one eye, which was treated with additional procedure. Visual acuity improved in six eyes (60%), unchanged in three eyes (30%) and declined in one eye (10%).
  
  
  CONCLUSIONS
  The MSTK combined with conjunctival flap covering seems to be effective for refractory corneal perforation in severe SJS.
authors.forename: Fuhua
authors.initials: F
authors.lastname: Wang
authors.forename: Suxia
authors.initials: S
authors.lastname: Li
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
authors.forename: Hua
authors.initials: H
authors.lastname: Gao
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan 250021, P,R, China. weiyunshi@163.com.
authors.forename: Weiyun
authors.initials: W
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000473:pathology; D003228:Conjunctiva / Q000637:transplantation; D057112:Corneal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000175:diagnosis; D013524:Surgical Flaps; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
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