Indian Journal of Ophthalmology

ORIGINAL ARTICLE
Year
: 1980  |  Volume : 28  |  Issue : 3  |  Page : 111--113

Emergency keratoplasty in perforating corneal ulcers and ring abscess of cornea


Dhanwant Singh, RPS Gill, SPS Grewal 
 Department of Ophthalmology, Govt. Medical College, Patiala, India

Correspondence Address:
Dhanwant Singh
Deptt. of Ophthalmology, Govt. Medical College, Patiala
India




How to cite this article:
Singh D, Gill R, Grewal S. Emergency keratoplasty in perforating corneal ulcers and ring abscess of cornea.Indian J Ophthalmol 1980;28:111-113


How to cite this URL:
Singh D, Gill R, Grewal S. Emergency keratoplasty in perforating corneal ulcers and ring abscess of cornea. Indian J Ophthalmol [serial online] 1980 [cited 2020 Nov 29 ];28:111-113
Available from: https://www.ijo.in/text.asp?1980/28/3/111/28237


Full Text

Therapeutic corneal grafting for corneal ulcers is being now done more frequently. In cases of sloughing corneal ulcers keratoplasty is the only hope for a badly damaged and necrosed cornea to retain some visual function.

The present study relates to our experience of emergency keratoplasty in cases of sloughing corneal ulcers and ring abscess of the cornea.

 MATERIALS AND METHODS



The study was carried out in 2.5 cases of sloughing corneal ulcers and ring abscess of the cornea where emergency keratoplasty was per­formed. 16 cases had sloughing corneal ulcers and 9 cases had ring abscess. Bacteriological studies done at the time of admission revealed the presence of Staph. aureus-3 cases, Pseudomonas pyocyaneus-3 cases and E. coli in one case.

In 18 cases, no organism could be cultured. All the patients failed to respond to conven­tional medical treatment for corneal ulcer which was tried for twelve to thirty days. Therapeutic keratoplasty was done as a last resort to save the eye. 8mm to 10mm full thickness graft was used. Anterior chamber was washed with normal saline and gentamicin solution in 6 cases with hypopyon ulcer. Mechanical removal of the fibrinous exudates with the forceps was necessary in 4 cases. Lens was removed with cryoprobe in 3 cases. Continuous monofilament nylon sutures were applied in all the cases.

 OBSERVATIONS



The patients were followed post operatively for a period ranging from 3 to 6 months. Structural success was obtained in all cases. 12 cases (48%) had clear graft, 7 cases (28%) had hazy grafts and 6 cases (24%) had opaque graft. In 12 cases of clear graft the post­operative visual acuity ranged from finger counting to 6/18 [Figure l]a,b, [Figure 2]a,b, [Figure 3]a,b.

 DISCUSSION



In the past, keratoplasty has been done with success in cases of corneal ulcers by various workers.[1],[2],[3],[4],[5] Malik and Singh[5] were able to save structurally 85.7% of the eyes with Pseudomonas pyocyaneus and post-operative visual acuity in their series varied from 6/60 to 6/12 in 39.2% of the cases. In the present series structural success was obtained in 100% cases and the postoperative visual acuity ranged from finger counting to 6/18 in 48% cases. The incidence of graft reaction in our series was 32%. Hypopyon and exudates in the anterior chamber did not influence the progno­sis. However pus must be washed out with normal saline at the time of operation followed by a wash with antibiotic solution. The post­operative complications observed in our series were shallow anterior chamber and anterior synechiae 5 cases (20%), secondary glaucoma 4 cases (16%), Uveitis I case (4%), hyphaema I case (4%), epithelial oedema 2 cases (8%), epithelial graft ulcer 3 cases (12%) and graft reaction 8 cases (32%).

We did not observe any case of iris pro­lapse or graft necrosis.

 SUMMARY



Penetrating keratoplasty was done in per­forating corneal ulcers and sloughed out cornea with ring abscess. It is concluded that

(i) Sutures should be applied in healthy part of the host cornea.

(ii) Pus and hypopyon in anterior chamber do not influence the prognosis.

(iii) Infection is invariably controlled after keratoplasty.

References

1Arentosen, J.J., 1976, Amer. J. Ophthalmol., 81:313.
2Thiagarajan, S. 1976, Acta Sixth Afro Asian Congress of Ophthalmology Madras, India p. 91-94.
3Malik, S.R.K. and Singh G., 1971, Brit. J. Ophthalmol. 55: 326.
4Sanders, N., 1970, Amer J. Ophthalmol. 70, 24.
5Singh, G. and Malik. S.R K., 1972, Brit. J. Ophthalmol. 56: 41.