Tectonic sclerokeratoplasty and tectonic penetrating keratoplasty as treatment for perforated or predescemetal corneal ulcers.

PURPOSE: To report the clinical outcome of patients with perforated or predescemetal corneal ulcers treated by tectonic, centric or eccentric penetrating keratoplasty or by tectonic sclerokeratoplasty. DESIGN: Nonrandomized clinical trial. METHODS: The study included 60 patients (60 eyes) with perforated or predescemetal corneal ulcers who were consecutively operated on by the same surgeon. Fifty-two patients underwent tectonic penetrating centric or eccentric keratoplasty. Eight patients with paralimbal corneal ulcers underwent tectonic sclerokeratoplasty. A control group consisted of 76 patients (76 eyes) electively undergoing central penetrating keratoplasty for treatment of inactive central corneal scars. RESULTS: In the study group with perforated or predescemetal corneal ulcers, best-corrected postoperative visual acuity ranged from perception of light to 0.80 (median, 0.10), with 54 of 60 eyes (90%) attaining an improvement of best visual acuity. In 10 of 60 patients (16.7%), tectonic penetrating keratoplasty had to be re-performed because of a recurring corneal ulcer. Patients with sclerokeratoplasty and patients with eccentric keratoplasty did not differ in clinical outcome, despite larger trephine and corneal lesion size in the sclerokeratoplasty group. Among study patients compared with control patients, postoperative visual acuity was significantly lower (P =.01), postoperative refractive and keratometric astigmatism were significantly higher (P <.05), and immunologic graft reactions (P =.02) and suture loosening (P <.001) occurred significantly more often. CONCLUSIONS: Eyes with perforated corneal ulcers or predescemetal corneal ulcers can usually be saved by tectonic keratoplasty or sclerokeratoplasty, with a moderate to considerable amount of remaining useful vision. In case of doubt, one may prefer conservative treatment of corneal ulcers and to electively perform central keratoplasty when the ulcers have healed. For selected clinical situations, sclerokeratoplasty is an alternative to keratoplasty for surgical treatment of paralimbal corneal defects.