Combined Surgery For Complex Perforating Corneal Trauma

OBJECTIVE: To explore the effect, method, complication of combined surgery on complex perforating corneal trauma.METHODS: 96 cases of complex perforating corneal trauma were re reported, including all patients who underwent combined and sequential surgeries between 2000 and 2002. 72 cases underwent combined surgery, 24 cases underwent sequential surgery. Visual outcome are reported with detailed analysis for combined and sequential surgeries. The occurrence of intraoperative and postoperative complications is reported. Specular microscopy of donor corneal endothelium was performed on 12 patients who underwent combined penetrating keratoplasty. The thickness of donor cornea was measured.RESULT: (1) After an average follow up of 18.5 months, 61 (84.7%) eyes had a visual acuity of at least 0.1, 49(68.1%) eyes had visual acuity of at least 0.3 in combined surgery group; 19 eyes (79.2%) had visual acuity of 0.1 or better, lleyes (45.8%) had visual acuity of 0.3 or better. Corrected postoperative visual acuity in the combined surgery group wasthe same as in the sequential surgery group (x2=1.32, P>0.05; x2=1-87, P>0.05). (2) The intraoperative and postoperative complications include inflammatory reaction, vitreous opacity, retinal detachment, secondary cataract, removal of IOL and graft rejection. The occurrence ofcomplication in combined surgery group was the same as in the sequential surgery group except that of inflammatory reaction and vitreous opacity. The inflammatory reaction was more severe and longer in the combined surgery group. The occurrence of vitreous opacity were 32.0% and 18.8 %( P<0.05). (3) The loss rate of corneal endothelium was 34.98% in postoperative 1.5-2 years. The average area of the donor corneal endothelium and the CV increase. The percentage of hexagonal cells of donor corneal endothelium decreased after operation 1.5~2years. The thickness of grafts was normal.CONCLUSION: (1) The combined surgery for complex perforating corneal trauma has been proved successful, producing good visual result and causing no sight-threatening complications. It could be a good option in selected cases. (2) After combined penetrating keratoplasty, the density of donor corneal endothelium would decrease the average cell area and CV increase and the hexagonality decrease. Combined penetrating keratoplasty was a safe surgery.