Clinical Observation of Corneal Stromal Lenticules Combined with Bioengineered Corneal Transplantation for Treatment of Infectious Corneal Ulcer with Perforation
Abstract：Objective: To investigate the effcacy and safety of corneal stromal lenticules combined with bioengineered corneal transplantation in the treatment of infectious corneal ulcer with perforation. Methods: In this retrospective case series study. From January 2021 to December 2021, totally 24 patients (24 eyes) with infectious corneal ulcer and perforation who received corneal stromal lenticules combined with bioengineered corneal transplantation in Xi'an People's Hospital (Xi'an Fourth Hospital) were selected, including 10 eyes with bacterial corneal ulcer and perforation, 9 eyes with viral corneal ulcer and 5 eyes with fungal corneal ulcer and perforation. The corneal ulcer area were all located in the non pupillary area, and the perforation diameter was 3.13 ± 0.92 (2-4) mm. The visual acuity, intraocular pressure, corneal astigmatism, infection recurrence, complications and graft rejection were observed. Results: All operations were successfully completed. The follow-up ranged from 13.2 ± 2.2 (6-18) months. The best corrected visual acuity before operation was light perception-0.12, of which 18 eyes were less than 0.1 and 6 eyes were 0.1-0.25. The last follow-up was 0.02-0.8, of which 5 eyes were less than 0.1, 9 eyes were 0.1-0.25, 7 eyes were 0.3-0.5, and 3 eyes were more than 0.5. Postoperative corneal astigmatism: 1.76 ± 0.81 (1.1-3.5)D at the last follow-up. The graft thickness measured at the last follow-up was 518 ± 33 (485-561) μm. In 2 cases, the anterior chamber hemorrhage was caused when the incarcerated iris was returned during the operation, and a small amount of viscoelastic agent was retained. The anterior chamber hemorrhage was completely absorbed at 3 and 5 days after the operation, respectively. All patients completed epithelialization of the grafts at 3-7 days after operation, and the bioengineering grafts gradually became transparent. One patient developed mild double anterior chamber at the second day after operation which disappeared after 3 days of pressure bandaging. Up to the last follow-up, there was no recurrence of primary infection. Two patients with primary lesions near the corneal limbus developed edema and neovascularization at the local edges of the grafts at 2 months and 5 months after surgery. The local sutures were removed in time and the grafts were gradually transparent after intensive use of glucocorticoid and tacrolimus; one patient developed severe rejection after discontinuing all ophthalmic drugs for special reasons at 6 months after surgery, and underwent conjunctival fap covering surgery. In other patients, the implant, matrix lens gasket and the implant bed were closely attached, with great healing and good transparency. Conclusions: Corneal stromal lenticules combined with bioengineered corneal transplantation is a safe method for the treatment of infectious corneal ulcer with perforation, which is not limited by the shortage of donor corneal materials and have a good visual recovery after operation.
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