Furundaoturan Onur, Palamar Melis, Egrilmez Sait, Yagci Ayse, Barut Selver Ozlem
Department of Ophthalmology, Kars Harakani State Hospital, Kars, Turkey.
Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey.
Clin Exp Optom. 2025 Aug;108(6):669-675. doi: 10.1080/08164622.2024.2411415. Epub 2024 Oct 6.
Non-traumatic aetiologies are one of the leading causes of corneal perforations. The management of corneal perforation is quite challenging and complex for anterior segment surgeons. The appropriate surgical approach for each case is usually determined on the basis of a combination of many different parameters.
The study aimed to evaluate surgical approach options and outcomes in the treatment of non-traumatic corneal perforations.
Patient data who underwent surgery for non-traumatic corneal perforation between 2016 and 2023 were retrospectively evaluated. Medical records were assessed in terms of age, gender, perforation aetiology, the first and last examination notes, surgical approach, follow-up time, and additional surgeries and outcomes according to anatomical, therapeutic and functional success. Anterior segment photographs were investigated for thorough explanation of the examinations.
Forty-five eyes of 45 patients were included (mean age 61.2 ± 22.4 (90-2), female/male ratio 20/25). Surgical approaches applied according to the size and location of the perforation site included fibrin glue application (6), amniotic membrane transplantation (AMT) (9), corneal patch graft application(15), and tectonic keratoplasty (15). The ratio of inflammatory and infectious causes as the two main indications was 29/16. Globe integrity was ensured with the first surgery in 27 eyes. However, 17 eyes required secondary surgical attempts due to failure of the first approach and 1 eye underwent evisceration. AMT was the least successful method among other methods in anatomical, therapeutic, and functional assessment.
There are various surgical approaches for repairing non-traumatic corneal perforations, each with its own advantages and disadvantages. These include high tissue resistance, the ability to remove necrotic tissue, ease of access, and anti-inflammatory activity. It is possible to successfully repair corneal perforations with single and combined methods, considering the above-mentioned features, especially depending on the size and location of the defect. While AMT is a viable and time-saving choice - especially in the lack of donor tissues - further interventions are necessary in most circumstances.
非创伤性病因是角膜穿孔的主要原因之一。对于眼前段外科医生而言，角膜穿孔的处理极具挑战性且复杂。通常需综合多种不同参数来确定针对每个病例的合适手术方法。
本研究旨在评估非创伤性角膜穿孔治疗中的手术方法选择及疗效。
对2016年至2023年间接受非创伤性角膜穿孔手术的患者数据进行回顾性评估。根据年龄、性别、穿孔病因、首次及末次检查记录、手术方法、随访时间以及根据解剖学、治疗学和功能学成功情况的额外手术及疗效对病历进行评估。研究前段照片以全面解释各项检查。
纳入45例患者的45只眼（平均年龄61.2±22.4（90 - 2）岁，女性/男性比例为20/25）。根据穿孔部位的大小和位置应用的手术方法包括纤维蛋白胶应用（6例）、羊膜移植（AMT）（9例）、角膜补片移植（15例）和结构性角膜移植术（15例）。炎症和感染性病因作为两个主要指征的比例为29/16。27只眼通过首次手术确保了眼球完整性。然而，17只眼因首次手术失败需要二次手术尝试，1只眼进行了眼球摘除术。在解剖学、治疗学和功能学评估中，AMT是其他方法中最不成功的方法。
修复非创伤性角膜穿孔有多种手术方法，每种方法都有其优缺点。这些优点包括高组织抵抗力、去除坏死组织的能力、易于操作和抗炎活性。考虑到上述特征，尤其是根据缺损的大小和位置，采用单一和联合方法成功修复角膜穿孔是可行的。虽然AMT是一种可行且节省时间的选择——尤其是在缺乏供体组织的情况下——但在大多数情况下仍需要进一步干预。
