Corneal Perforation in a Premature Infant

Management of inflammatory corneal melt leading to central perforation in children: a retrospective study and review of literature

PURPOSE

To assess the outcome of early therapeutic penetrating keratoplasty (PKP) for corneal melt leading to perforation in children.

METHODS

Case notes of all the consecutive patients presenting with acute corneal perforation that underwent urgent therapeutic PKP between 2000 and 2010 to the practice of one of the authors, both NHS at Great Ormond Street Hospital for Children and private, were retrospectively reviewed. Onset of perforation, underlying cause, medical and surgical treatment, pre- and post-operative visual acuity, graft clarity, length of follow-up, and post-operative complications were recorded.

RESULTS

Four eyes of four consecutive patients (mean age of 9.5 years and median 8.5 years, range 4-17 years) were treated for acquired acute onset corneal perforations. There were three females and one male. Etiologies included herpes simplex keratitis secondary to immune recovery disease post bone marrow transplantation, acanthamoeba keratitis, recessive dystrophic epidermolysis bullosa, and blepharokeratoconjunctivitis with acne rosacea. Pre-operative visual acuity ranged from hand movements to 6/150. All the patients had severe anterior chamber inflammation. All eyes improved in visual acuity ranging from 6/9 to 6/18 with clear grafts at last follow-up. There was no recurrence of melt or perforation. Mean follow-up was 67 months (median 44 months).

CONCLUSION

PKP during the acute phase together with aggressive medical therapy and close follow-up may achieve good visual outcomes in children with corneal melt with perforation and should be considered. Waiting may sometimes allow the marked inflammatory response seen in children to cause irreversible structural and/or functional damage.

Corneal perforation with secondary congenital aphakia in Peters anomaly

PURPOSE

To describe two cases of secondary congenital aphakia in association with Peters anomaly.

METHODS

Two infants were noted to have corneal opacification at birth. Each child was found to have Peters anomaly requiring corneal transplantation in 1 or both eyes.

RESULTS

Each child underwent penetrating keratoplasty, revealing absence of the crystalline lens in 1 eye. Histopathologic evaluation of the corneal buttons was performed. Each specimen showed full-thickness corneal defects with lens remnants.

CONCLUSIONS

Secondary congenital aphakia from corneal perforation should be considered in the presentation of severe Peters anomaly.