From the Guidelines
Coreoplasty is not a recommended procedure for the treatment of corneal ectasia or edema, as the provided evidence does not support its use in these conditions. The most recent and highest quality study, 1, discusses the indications for keratoplasty in the treatment of corneal ectasia, including persistent corneal edema following hydrops and deep stromal scarring.
Indications for Keratoplasty
- Keratoplasty is indicated when a patient can no longer achieve functional vision with eyeglasses and contact lenses.
- Persistent corneal edema following hydrops is an indication for full-thickness keratoplasty.
- Penetrating keratoplasty may be preferred over DALK in cases of deep stromal scarring.
Keratoplasty Techniques
- Lamellar graft can be performed for tectonic support as a primary procedure, and additional PK can be performed later for visual rehabilitation.
- Large-diameter PK has been used successfully in patients with pellucid marginal degeneration. The decision to perform keratoplasty should be based on the severity of symptoms, visual impairment, and the patient's overall condition, as discussed in 1 and 1.
Considerations for Keratoplasty
- The choice of keratoplasty technique depends on the underlying condition and the extent of corneal damage.
- Endothelial keratoplasty has supplanted PK as the procedure of choice in cases of endothelial failure when corneal scarring is minimal, as mentioned in 1.
- The patient should be monitored for potential complications, such as graft dislocation, lamellar interface infection, and endophthalmitis, as discussed in 1.
From the Research
COREOPLASTY Indication
- Corneal ulcerations are a medical emergency, and in recalcitrant cases, leading to perforation, a surgical ophthalmological emergency 2
- The urgency of the treatment is dictated by the necessity of preventing complications that can lead to serious ocular morbidities 2
- Surgical intervention is indicated when persistent corneal ulceration does not respond to medical treatment, including antibiotics, therapeutic soft contact lenses, or tarsorrhaphy 3
- Keratoplasty is valuable for maintaining the ocular integrity and visual acuity, and is considered in cases of corneal perforation, including those caused by herpetic keratitis, bacterial ulcer, fungal ulcer, neurotrophic ulcer, and other conditions 4
- The decision to perform keratoplasty is guided by the location, size, and underlying etiology of the perforation, as well as the presence of any underlying conditions such as ocular surface disease or autoimmune disorders 5
Conditions Leading to COREOPLASTY
- Corneal ulceration leading to perforation can occur secondary to a number of conditions, including infection, trauma, corneal dryness, and exposure keratitis 3
- Corneal ectasia, including keratoconus, may also require keratoplasty in advanced cases or when other treatments are not effective 6
- Other conditions that may lead to corneal perforation and potentially require keratoplasty include rheumatoid arthritis, Mooren ulcer, Terrien marginal corneal degeneration, and Wegener granulomatosis 4