Clinical and surgical outcomes of tectonic corneal patch grafts : insights from a tertiary referral hospital.

Abstract

Purpose: This study aimed to report the clinical characteristics, surgical indications, outcomes and long-term complications of full-thickness or lamellar corneal patch grafts for various indications.

Material-method: This retrospective study included 48 eyes of 47 patients who underwent full-thickness or lamellar corneal patch keratoplasty for treatment of corneal perforation, melting and descemetocele. Patient demographics, preoperative features, best-corrected visual acuity before and after surgery, mean follow-up time, corneal graft type, long-term complications, need for additional surgery, and anatomical success were analyzed.

Results: Of the 48 eyes, 21 had corneal perforation, 21 had severe corneal melting, and six had descemetocele. Sjögren's syndrome (eight eyes, 16.7%), trauma (eight eyes, 16.7%), and limbal stem cell deficiency (eight eyes, 16.7%) were the most common indications for corneal patch grafting. The most common complications after surgery were graft melting (11 eyes, 22.9%) and glaucoma (5 eyes, 10.4%). One eye developed phthisis bulbi. Penetrating keratoplasty was performed in 8 of the 11 eyes with recurrent graft melting. All descemetocele cases were central and corneal melts were more frequently located paracentrally (p = 0.0001). Anatomical success was achieved in 39 eyes (81.2%).

Conclusion: Corneal patch grafting is a safe and effective method for maintaining ocular integrity in corneal melting and perforation that can not be closed using conventional methods. With a success rate of over 80%, corneal patch grafts can delay a larger full-thickness graft, especially in eyes with acute inflammation, until systemic therapy is effective.