Incidence of Choroidal Detachment Following Corneal Ulcer Perforation

Abstract

Purpose: : To determine the incidence of choroidal detachment (CD) in eyes with non–traumatic corneal ulcer perforation and secondly to assess the efficacy and safety of cyanoacrylate glue in sealing corneal perforations.

Methods: : 18 eyes of 17 patients were recruited into the study. Inclusion criterion was any patient with a non–traumatic perforated corneal ulcer. All patients had a thorough history and complete ophthalmic examination including B–scan ultrasonography. Patient demographics, presence of CD, and efficacy of corneal gluing were assessed.

Results: : Eight of the 18 eyes (44%) were documented to have a CD. Amongst perforations of greater than 2mm² , 6 eyes (75%) were documented to have CD compared with 2 eyes (20%) in perforations of less than 2mm² (P=0.054). No correlation could be determined between perforation duration and incidence of CD. Of the 15 eyes that underwent gluing, there were 13 successes (87%) and 2 failures (13%). Within the successes 4 patients (27%) required re–gluing because of infection (1 patient) or progression of their corneal melting (3 patients). Failure was due to severe progression of melting (1patient) and a very large perforation (1 patient).

Conclusions: : Choroidal detachment following corneal ulcer perforation is common and is more likely in larger corneal perforations. Preoperative B–scan should be considered in cases of large corneal perforations requiring therapeutic keratoplasty to document choroidal detachment, which if large, may require drainage. Cyanacrylate glue is an effective and safe method for sealing small corneal perforations. A vigil must be maintained for infection while the glue and bandage contact lens are in situ.

Keywords: clinical (human) or epidemiologic studies: prevalence/incidence • cornea: clinical science • transplantation