Journal of Clinical and Experimental Ophthalmology
Open Access
ISSN: 2155-9570
+44 1223 790975
ISSN: 2155-9570
+44 1223 790975
Wessam N Salem
New Giza University, Egypt
Dar El Oyoun Hospitals, Egypt
Eye Subspecialty Center, Egypt
Scientific Tracks Abstracts: Clin Exp Ophthalmol
Background: Corneal perforations after corneal ulcers are ocular emergencies with myriad causes, such as trauma, infection,
autoimmune diseases and loss of corneal innervation. Knowledge of the cause of the perforation is essential for its proper
management. Treating perforated corneal ulcer with a therapeutic PKP (Penetrating Keratoplasty) is the best option to
eliminate active infection or to treat a perforation larger than 2 mm that involves tissue loss.
Materials & Methods: Female patient 56 years old came presenting with corneal melting and perforation after long history
of corneal abscess with multiple failure of healing. Patient came seeking medical advice in February 2018 in Eye Subspecialty
Center, Cairo, Egypt. She has IDDM (Insulin-Dependent Diabetes Mellitus) for 10 years and no past ophthalmic surgeries.
Vision was HM BP Hand Moment Blood Pressure. Slit lamp exam showed faint descemetocele with impending perforation.
Surgical Procedure: (1) Under general anesthesia, sterilization of the eye lids was done and surrounding skin using povidone
iodine 10%. (2) Centration of the pupil was done using specific surgical marker and then using corneal marker for the
stitches was applied. (3) Opening a side port using a 1.2 mm MVR and injecting viscoelastic material to allow formation of
the anterior chamber. (4) Trephining the host cornea was done using a 7.75 mm trephine and the donor graft was cut using
7.5 mm punch. (4) Trimming the edges of the host tissue with application of the donor graft and suturing using 10/0 nylon
16 stitches. Postoperative Assessment: Patient was prescribed topical and systemic antibiotics, topical and systemic steroids,
topical antiglaucomatous drops and systemic analgesics. Post-operative visits were done one day, one week, 3 weeks. Patient
showed improvement in graft edema with regressed signs of inflammation and rejections. Patient subsequently development
complicated cataract that was scheduled for removal 6 months post-operatively.
Results: Patient received a therapeutic corneal graft maintaining the integrity of the eye, preserving the anatomy of the globe
and eliminating the source of infected tissue.
Conclusion: Therapeutic penetrating keratoplasty is one of the vision preserving measures in cases of large perforated corneal
ulcers not responding to other treatment options.
Wessam N Salem has graduated as ophthalmologist from the School of Medicine, Cairo University, Egypt. He has started his specialized medical career as an Ophthalmology Resident in Cairo University, in addition to his experience at the military hospitals. He has participated in several medical exchange programs abroad including Austria, Hungary and Germany. He has obtained his Master in Ophthalmology from Cairo University, Egypt. Besides being an Assistant Lecturer of Ophthalmology, School of Medicine, New Giza University, he works as a Refractive Surgeon in Dar El Oyoun Hospital and Eye Subspecialty Center, Cairo, Egypt. Presently he is working on his Fellowship in the Royal College of Surgeons of Edinburgh, after being a Member of the International Council of Ophthalmology and the Royal College of Surgeons of Edinburgh.