Abstract
Purpose :
To report etiology, characteristics, treatment and main outcomes of non-traumatic corneal perforations in a single referral center.
Methods :
A retrospective review of clinical records of patients diagnosed with non-traumatic corneal perforation treated over a 5-year period were analyzed. The data included demographic characteristics, medical history, initial and final corrected distance visual acuity (CDVA), perforation etiology (non-infectious and infectious), size, location, initial therapy, surgical treatment, ocular integrity and complications. The comparison in the distribution between the non-infectious and infectious groups was performed with a Pearson's chi-squared test. Different variables were analyzed through a multiple logistic regression analysis for the probability to have a second procedure(s).
Results :
We included 127 eyes of 116 patients (69 female and 47 male) with a mean age of 50 years (range 5 to 81 years) and a mean follow up of 11 months. Eleven patients presented bilateral corneal perforation, 9 of which had rheumatoid arthritis (RA). The most common systemic comorbidity was RA (44.8%). The initial CDVA was 3.00 logMAR and the final CDVA was 2.30 logMAR (p>0.56). Regarding treatment, of the 49 eyes with an initial cyanoacrylate patch, 14 (28.6%) eyes did not required any further treatment; whereas 35 eyes (71.4%) had at least one more procedure (p>0.001). In comparison, of the 49 eyes with an initial tectonic keratoplasty, 33 (67.3%) eyes remained stable while 16 (32.7%) eyes needed one or more interventions (p=0.004). In a multiple logistic regression analysis an initial cyanoacrylate patch represented a probability of 4.7 times to require a subsequent procedure. Overall, ocular integrity was achieved in 96.1% of the cases.
Conclusions :
Corneal perforations represent an important cause of ocular morbidity. An appropriate treatment should be based according to etiology, size and location of the perforations. The use of a cyanoacrylate patch is useful as an initial therapy in small and central perforations, however, procedures such as keratoplasty or amniotic membrane grafts may be necessary to achieve anatomical success.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.