Author has performed 5 cases of conjunctival flap for the viral deratitis. 1) Histologically, there were many methods for the viral diseases of the cornea. However, the results were not so satisfactory. 2) Author experienced the prevention of corneal perforation by this method. 3) The result was very satisfectory.
Cornea* ; Corneal Perforation ; Virus Diseases

OBJECTIVE: To determine the bonding strength of 2-octyl cyanoacrylate (Dermabond) compared with N-Butyl-2-cyanoacrylate (Histoacryl) and nylon 10-0 (Alcon,) in sealing experimentally induced corneal perforations in cadaver porcine eyes. METHODS: This is a single-blind, randomized, physical experimental study involving 78 freshly enucleated porcine eyes in which perforations of 3.0 and 5.1 mm were made in the cornea and randomly sealed with either interrupted nylon 10-0 (n=13), Dermabond (n=13), or Histoacryl (n=13). Intraocular pressures were raised by injecting normal saline into the anterior chamber and postsealing leaking pressures were measured using a precalibrated manometer attached to the anterior chamber maintainer. Fishers Exact Test was used to determine the difference in proportion of eyes that leaked, and Wilcoxon signed ranked test to compare the mean leaking pressures. RESULTS: In the 3.0 mm group, the proportion of eyes that leaked in Dermabond (2/13, 15.4 percent) and Histoacryl (1/13, 7.7 percent) were comparable (p=1.00). Proportion of leak in nylon 10-0 (13/13, 100 percent) was significantly higher (p0.001). Mean leaking pressures of Dermabond (79.5 mm Hg) and Histoacryl (88.0 mm Hg) were higher compared with that of nylon 10-0 (61.44 mm Hg) (p 0.05). In the 5.1 mm group, proportion of eyes that leaked in Dermabond (4/13, 30.8 percent) and Histoacryl (2/13, 15.4 percent) were comparable (p=0.07 AND P=0.10). CONCLUSION: The bonding strengths of Dermabond and Histoacryl are comparable and greater than that of nylon 10-0. Both are effective for 3.0 mm and 5.1 mm corneal perforations.
Animal ; CYANOACRYLATES ; ENBUCRILATE ; CORNEAL PERFORATION

The posterior surface of the rabbit's cornea was scraped by a spatula or incised by a cystotome, followed by injection of alpha-chymotrypsin or trypsin into the anterior chamber. The concentration of enzymes used were 5mg/cc and O.5mg/cc of alpha-chymotrypsin and 5.000 Anson unit/cc and 500unit/ cc of trypsin. Three minutes after the introduction of enzymes into the anterior chamber, irrigation of the anterior chamber with normal saline was performed. The cornea was examined macroscopically and biomicroscopica11y for about 3 weeks. Histological examination was done on the 3rd and the 11th post-operative days. The cornea was affected more intensively and extensively when the stroma was injured than when only the endothelium was injured. Alpha-chymotrypsin was more toxic to the cornea than trypsin and led sometimes to a corneal perforation.
Anterior Chamber ; Cornea* ; Corneal Perforation ; Endothelium ; Trypsin*

Adult ; Corneal Perforation ; surgery ; Humans ; Male

PURPOSE: To evaluate the efficacy of five-layered reinforced amniotic membrane (AM) transplantation for treating deep corneal ulcer or perforation. CASE SUMMARY: We performed a five-layered reinforced AM transplant in three cases of corneal ulceration or perforation using mechanical compressed lyophilized AMs. In all cases, the perforated cornea healed with re-epithelization within 2 weeks and the ocular surface was stabilized for more than 1 year. CONCLUSIONS: Five-layered reinforced AM transplantation may be an alternative method for treating deep corneal ulcers or perforations.
Amnion ; Cornea ; Corneal Perforation ; Corneal Ulcer ; Transplants ; Ulcer

PURPOSE: To evaluate the clinical outcome of multilayer amniotic membrane transplantation (AMT) in the cornea which was perforated or had impending perforation due to corneal ulcer. METHODS: Human multilayer amniotic membrane transplantation were performed in patients with perforation or impending perforation of cornea due to herpetic keratopathy (2 eyes of 2 patients) and fungal ulcer (1 eye). The surgical procedure consists of the following steps: First, all cellular debris was carefully removed from the base and the walls of the ulcer and loosened epithelium. In addition 1 to 2 mm zone is created around the ulcer by removal of healthy, adherent epithelium overlaying the normal Bowman membrane. Depending on the depth and the configuration of the ulcer, three or more of small pieces of human amniotic membranes are stacked one above the others to fill the cavity of the ulcer. Finally, a larger piece of membrane is trimmed to cover the ulcer and then secured with interrupted 10-0 nylon suture. RESULTS: The corneal perforations were prevented and the stable ocular surface were achieved in all patients. CONCLUSIONS: Human multilayer amniotic membrane transplantation is a useful treatment prior to corneal transplantation and considered as an alternative treatment to keratoplasty for perforation or impending perforation of corneal ulcer.
Amnion* ; Bowman Membrane ; Cornea ; Corneal Perforation ; Corneal Transplantation ; Corneal Ulcer* ; Epithelium ; Humans ; Membranes ; Nylons ; Sutures ; Ulcer

To evaluate the efficacy of amniotic membrane ransplantation(AMT) in the cornea that was perforated or impending perforation due to recalcitrant corneal ulcer or trauma, we performed AMT on 1 case of acid burn, 2 cases of thermal burn, 1 case of corneoscleral staphyloma with bullae due to previous ocular trauma, 2 cases of keratolysis as a graft rejection after keratoplasty, 3 cases of corneal ulcer. We used one or several layers of amniotic membrane(AM) that preserved in DMEM solution and 10% glycerin(1:1) under-70 degrees C or lyophylized form. As a result, the corneal perforations were prevented and the stable ocular surface were achieved. However, in case of neurotrophic keratopathy, epithelial rebreakdown was occurred after AMT, eventually epithelalization was fulfilled. Therefore, AMT may be a effective alternative method for treating corneal perforation or impending perforation that are refractory to conventional treatment.
Amnion* ; Burns ; Cornea* ; Corneal Perforation ; Corneal Transplantation ; Corneal Ulcer ; Graft Rejection

PURPOSE: To evaluate the influence of corneal suturing on corneal perforation during LASIK. METHODS: Three eyes from three patients which were perforated during LASIK received corneal suturing and the effect of the suturing on the integrity of the corneas was analyzed. RESULTS: The development of keratectasia was prevented with sutures even though corneal perforation occurred during LASIK in the normal cornea. CONCLUSIONS: The development of keratectasia was prevented with corneal sutures on the perforated cornea during the LASIK, and it might be the result of suture itself and scars causing the adherence of the flap to the stromal bed.
Cicatrix ; Cornea ; Corneal Perforation* ; Humans ; Keratomileusis, Laser In Situ* ; Sutures

Although there had been many studies for evaluating an usefulness of expanded polytetrafluoroethylene(Gore-Tex(R)) as a temporary treatment of corneal perforation and a supporting skirt of keratoprosthesis, complications and instability of graft had limited the clinical applications. To find histopathologic factors that can contribute to the instability of graft and to try to modify the surgical methods with models of graft, serial examinations including biomicroscopy and histopathology were performed. According to the results, we were able to divide the causes of instability into two categories as a function of time. Epithelial down growth into the interface between graft and cornea with absence of epithelial coverage over the graft may cause leakage from anterior chamber in early period. Absence of fibrovascular invasion into Gore-Tex(R) resulting no cohesion between graft and cornea might be a factor of instability in late period. Based on these results, modification of surgical techniique and models of graft are needed. Several methods of modificiation are suggested in this report.
Anterior Chamber ; Cornea ; Corneal Perforation* ; Keratoplasty, Penetrating* ; Rabbits* ; Transplants

One hundred and fourteen patients(72 males and 42 females) who received a conjunctival flap for uncontrollable corneal ulcers with medical therapy between June 1983 and October 1994 were studied retrospectively. The range of the patients' ages were 7 to 81 years in which 60s' were popular and the patients were followed up for 15.2 months in average. Major underlying conditions of the patients were microbial infection(40%, 46 eyes) and trauma (25%, 29 eyes). The pathogenic organisms were identified by culture in 35 cases. Gram positive organisms of which staphylococcus species were the commonest were found in 23 cases, while Gram negative organisms of which pseudomonas species were the commonest were found in 11 cases. The location of the corneal ulceration was central(48.2%, 55 cases), paracentral(25.4%, 29 cases), total(19.3%, 22 cases) and marginal(7.0%, 8 cases) in order. The methods of operations were consisted of bipedicle bridge flap(82 cases), total conjuncti val flap(20 cases) and partial conjunctival flap(12 cases) in which 108 cases could be followed up and 96 cases(89%) were healed completely with one operation. As a postoperative complication retraction and displacement (12 cases), melting(10 cases), corneal perforation under the flap(5 cases) and corneal staphyloma (3 cases) etc. were found. Conclusively, the conjunctival flap can be a choice of the procedure for improving corneal wound healing for persistent corneal ulceration recalcitrant to medical therapy.
Corneal Perforation ; Corneal Ulcer* ; Humans ; Male ; Postoperative Complications ; Pseudomonas ; Retrospective Studies ; Staphylococcus ; Ulcer* ; Wound Healing