Lamellar keratoplasty in the management of inflammatory corneal ulceration and perforation.

Corneal ulceration and perforation may occur in the course of several systemic and ocular inflammatory conditions. These serious complications may respond to systemic immunosuppression and conjunctival surgery, but tectonic keratoplasty is sometimes required. We report on 10 cases of corneal ulceration (of which 8 suffered perforation) in patients with rheumatoid arthritis, Stevens-Johnson syndrome and Mooren's ulceration which were treated by lamellar keratoplasty. Our microsurgical technique for lamellar keratoplasty benefited from the use of viscoelastic agents, cyanoacrylate adhesive and an adjustable stepped diamond knife. These recent advances have made this procedure as easy to perform as a penetrating keratoplasty. Lamellar keratoplasty virtually eliminates the risk of graft rejection and reduces the risk of perforation in the event of a subsequent exacerbation of the melting process. Surgery preserved the globe in all 10 cases, and the pre-operative visual acuity was maintained or improved in all but 1 case. Six patients achieved a visual acuity of 6/60 or better. Concomitant systemic immunosuppression was used in 6 cases and a subsequent penetrating keratoplasty performed in 3 cases. Lamellar keratoplasty provides a valuable method of preserving the integrity of the globe and maintaining useful vision in these difficult cases.