Corneal perforations should be treated as if infected
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All corneal perforations should be considered infected to provide better reconstructive outcomes, according to a speaker.
“The least you can do is antibiotics and a shield. You have time. You don’t have to panic. Reform and seal the chamber if you can, and the glue patch technique can be very useful for this,” Bruce Allan, MD, FRCS, said at the virtual European Society of Cataract and Refractive Surgeons meeting.
When faced with an emergency corneal perforation, Allan said patients should be fitted with a Cartella shield to avoid further damage and be given a broad spectrum of systemic antibiotics to avoid infection. Surgeons should always perform a corneal scrape and microbiologic investigation as well, he said.
Surgeons should attempt to treat medically first to calm inflammation and give subsequent reconstruction the best possible outcomes. Often, a bandage lens is appropriate for a microperforation to reform the anterior chamber, he said.
“If the chamber is not reformed in half an hour, it’s not going to. Then you need to resort to gluing,” Allan said.
Glue patches can generally provide a good seal for a 3-mm to 4-mm perforation. Regenerative “bioglue,” which would act as a framework to allow the cornea to regenerate, may be available in the future to help surgeons avoid keratoplasties, he said.
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Allan B. Emergency care of corneal perforation. Presented at: European Society of Cataract and Refractive Surgeons meeting; Oct. 2-4, 2020 (virtual meeting).
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