title: Management of inflammatory corneal melt leading to central perforation in children: a retrospective study and review of literature.
abstract: OBJECTIVE
  To assess the outcome of early therapeutic penetrating keratoplasty (PKP) for corneal melt leading to perforation in children.
  
  
  METHODS
  Case notes of all the consecutive patients presenting with acute corneal perforation that underwent urgent therapeutic PKP between 2000 and 2010 to the practice of one of the authors, both NHS at Great Ormond Street Hospital for Children and private, were retrospectively reviewed. Onset of perforation, underlying cause, medical and surgical treatment, pre- and post-operative visual acuity, graft clarity, length of follow-up, and post-operative complications were recorded.
  
  
  RESULTS
  Four eyes of four consecutive patients (mean age of 9.5 years and median 8.5 years, range 4-17 years) were treated for acquired acute onset corneal perforations. There were three females and one male. Etiologies included herpes simplex keratitis secondary to immune recovery disease post bone marrow transplantation, acanthamoeba keratitis, recessive dystrophic epidermolysis bullosa, and blepharokeratoconjunctivitis with acne rosacea. Pre-operative visual acuity ranged from hand movements to 6/150. All the patients had severe anterior chamber inflammation. All eyes improved in visual acuity ranging from 6/9 to 6/18 with clear grafts at last follow-up. There was no recurrence of melt or perforation. Mean follow-up was 67 months (median 44 months).
  
  
  CONCLUSIONS
  PKP during the acute phase together with aggressive medical therapy and close follow-up may achieve good visual outcomes in children with corneal melt with perforation and should be considered. Waiting may sometimes allow the marked inflammatory response seen in children to cause irreversible structural and/or functional damage.
authors.affiliation: Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Medsinge
authors.affiliation: Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Gajdosova
authors.affiliation: Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK.
authors.forename: W
authors.initials: W
authors.lastname: Moore
authors.affiliation: Department of Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.|Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK.|University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: K K
authors.initials: KK
authors.lastname: Nischal
mesh_terms: D015823:Acanthamoeba Keratitis / Q000209:etiology / Q000601:surgery; D000208:Acute Disease; D000293:Adolescent; D001762:Blepharitis / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D057112:Corneal Perforation / Q000209:etiology / Q000601:surgery*; D016108:Epidermolysis Bullosa Dystrophica / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016849:Keratitis, Herpetic / Q000209:etiology / Q000601:surgery; D007637:Keratoconjunctivitis / Q000209:etiology / Q000601:surgery; D015948:Keratoplasty, Penetrating; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
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