Penetrating Keratoplasty for Perforated Corneal Ulcers: Preservation of Iris by Corneal Debulking

Purpose: This study was designed to study an alternative technique of lamellar separation of corneal layers for therapeutic keratoplasty in place of an en bloc removal of host corneal button in eyes with perforated corneal ulcers with pseudocornea. Methods: Twelve eyes with perforated corneal ulcers with pseudocornea in which therapeutic keratoplasty was planned were included in the study. A new technique was used in which the host corneal tissue was removed in layers by lamellar dissection started peripherally and proceeding centripetally with care taken to prevent perforation at the site of iris incarceration. After injection of viscoelastic into the anterior chamber with a 26-gauge needle entered tangentially, the deeper layer of the cornea was then gently dissected and peeled away from the iris tissue, with care not to avulse the fragile iris and the overlying fibrotic membrane. Adjunctive procedures were performed, and the donor tissue was secured over the host bed. Results: A complete separation of the iris tissue from corneal button and the fibrous membrane was achieved in 9 eyes. In 3 eyes, iris was partly trimmed along with the fibrous membrane, because the membrane was totally adherent to the iris tissue. Eight patients required pupilloplasty. Apart from minimal bleeding, no other complication was encountered. At the end of 3 months, 9 of 12 grafts remained clear. Conclusions: Debulking and layer-by-layer removal of host corneal tissue is effective in preservation of iris while performing therapeutic keratoplasty in eyes with perforated corneal ulcers with pseudocornea.