The results of therapeutic keratoplasties performed in severely thinned or perforated corneas

Purpose: To report the visual and anatomic outcomes of therapeutic keratoplasties performed in severely thinned or perforated corneas.Material and methods: Medical records of 37eyes of 37 patients operated between 2000 to 2014 were reviewed retrospectively. Indications, preoperative findings, surgical procedures, donor size, post-operative graft clarity, visual improvement, globe integrity and follow-up periods were analyzed. Mean age was 57,7 (20-85 ). Nineteen patients were male and 18 female. Mean follow-up was 28.7 (14-132) months.Results: Surgical indication was infectious in 17 (45.9%) and noninfectious in 20 eyes (54.1%). Infectious causes were bacterial ulcer 8 (21.7%), herpes simplex 7 (18.9%) and fungus in 2 (5.4%) eyes. Noninfectious causes were traumatic 6 (16.2%), Stevens-Johnson syndrome 2 (5.4%), desmatocele 2 (5.4%) other causes ( keratectasia, bullous keratopathy, acne rosacea, interstitial keratitis, lagophthalmos, and rheumatoid arthtritis). The underlying cause of cornel melting was unknown in 4 eyes (10.8%). Combined PK was performed in18 of 37 eyes (48.7%), PK alone in 14 (37.8%) and patch graft in 5 (13.5%). Graft survival rate was 30/37 (81.1%) through follow-up. Anatomical integrity was achieved in 23 (92.0%) of 25 perforated corneas. Visual improvement was obtained in 28 eyes (75.6%). Visual acuity was ≥ 0.05 in 6 eyes (16.2%) preoperatively, it increased to 22 eyes  (59.4%) post-operatively.Conclusion: Therapeutic keratoplasty including PK and patch grafting is an effective surgical procedure in patients with severe corneal melting or perforation due to varying aetiologies. It restores the globe integrity also provides visual improvement.