Surgical therapies for corneal perforations: 10 years of cases in a tertiary referral hospital.
OBJECTIVE
To report surgical therapies for corneal perforations in a tertiary referral hospital.


METHODS
Thirty-one eyes of 31 patients (aged 62.4±18.3 years) with surgically treated corneal perforations from January 2002 to July 2013 were included in this study. Demographic data such as cause of corneal perforation, surgical procedures, and visual outcomes were retrospectively analyzed.


RESULTS
The causes of corneal perforation (n=31) were divided into infectious (n=8, 26%) and noninfectious (n=23, 74%) categories. Infectious causes included fungal ulcer, herpetic stromal necrotizing keratitis, and bacterial ulcer. The causes of noninfectious keratopathy included corneal melting after removal of a metal foreign body, severe dry eye, lagophthalmos, canaliculitis, the oral anticancer drug S-1, keratoconus, rheumatoid arthritis, neurotrophic ulcer, atopic keratoconjunctivitis, and unknown causes. Initial surgical procedures included central large corneal graft (n=17), small corneal graft (n=7), and amniotic membrane transplantation (n=7). In two cases the perforation could not be sealed during the first surgical treatment and required subsequent procedures. All infectious keratitis required central large penetrating keratoplasty to obtain anatomical cure. In contrast, several surgical options were used for the treatment of noninfectious keratitis. After surgical treatment, anatomical cure was obtained in all cases. Mean postoperative best corrected visual acuity was better at 6 months (logMAR 1.3) than preoperatively (logMAR 1.8).


CONCLUSIONS
Surgical therapies for corneal perforations in our hospital included central large lamellar/penetrating keratoplasty, small peripheral patch graft, and amniotic membrane transplantation. All treatments were effective. Corneal perforation due to the oral anticancer drug S-1 is newly reported.
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Hideaki
H
Yokogawa
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Akira
A
Kobayashi
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Natsuko
N
Yamazaki
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Toshinori
T
Masaki
Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Kazuhisa
K
Sugiyama
amniotic membrane transplantation; corneal perforation; keratoplasty