One-year Data on Customised Deep Anterior Lamellar Keratoplasty for Peripheral Corneal Perforations at a Tertiary Care Centre in Switzerland.

ABSTRACT: PURPOSE: This retrospective study aims to evaluate the clinical outcomes of a customised "banana-shaped" anterior lamellar keratoplasty technique in the treatment of peripheral corneal ulcerative perforations in six patients treated at a tertiary care center in Switzerland over a one-year period.

ABSTRACT:

METHODS

In this retrospective observational study conducted between December 2023 and December 2024 at a tertiary care center in Switzerland, six patients (5 male, aged 48 - 86 years) with peripheral corneal ulcer perforations underwent a customized crescent-shaped ("banana-shaped") anterior lamellar keratoplasty. Three patients had perforations secondary to peripheral ulcerative keratitis (PUK) of autoimmune origin, one patient presented with a perforated neurotrophic corneal ulcer, another patient had a perforation due to surgically induced necrotizing scleritis, and the last patient had a perforation secondary to gonococcal keratoconjunctivitis. The corneal grafts were tailored to the size and location of the peripheral defects while preserving the central cornea. All patients were treated with topical corticosteroids and antibiotics postoperatively, with systemic therapy adjusted to the etiology of the ulceration. Outcomes assessed included graft clarity, epithelial healing, anatomical integrity, and best spectacle corrected visual acuity (BSCVA), with follow-up ranging from 6 to 12 months.

ABSTRACT:

RESULTS

Anatomical integrity of the globe was successfully restored in all six patients. All grafts remained clear, and epithelial healing was achieved within 10 days to 4 weeks. There were no cases of graft rejection or recurrent inflammation. Final BSCVA ranged from 0.7 to 0.3 logMAR.

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CONCLUSION

Customised "banana-shaped" anterior lamellar keratoplasty is a safe and effective surgical approach for the management of peripheral corneal ulcerative perforations, particularly in cases of PUK. This technique allows localised structural repair while preserving the central visual axis, resulting in favorable anatomical and visual outcomes.