MAR 17, 2009
Eighteen patients with corneal perforations between 0.6 mm and 3 mm in diameter and duration of less than two weeks were subjects in this case series. Perforations were sealed using TISSEEL VH Fibrin Sealant (Baxter Healthcare Corp.) human fibrin glue and bandage soft contact lenses. After three months, 15 (83.3 percent) of the corneal perforations had healed. All perforations that failed the treatment were larger than 2 mm in diameter.
Study inclusion criteria required that the perforations had no infiltrate or resolving infiltrates. Exclusion criteria were anterior staphyloma, progressive corneal infiltrates and stromal melting due to underlying collagen vascular disorders.
Perforation etiology was postinfectious in 11 (61.1 percent) cases, of which seven developed following bacterial keratitis and four after herpes simplex keratitis. Of the remaining seven (38.9 percent) eyes with noninfectious etiology, three had experienced chemical burn and one each of neurotrophic perforation, post-traumatic perforation, Mooren ulcer and graft-versus-host disease. The healing success rate was similar in perforations with postinfectious and noninfectious etiology.
One eye experienced a significant increase in deep corneal vascularization. Visual acuity improved in seven (38.9 percent) eyes after three months but did not reach better than 20/200 in any of the treated eyes.