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Penetrating Keratoplasty for Perforated Corneal Ulcers Under Topical Anesthesia

Mannan, Rashim MD; Sharma, Namrata MD; Pruthi, Archna MD; Maharana, Prafulla K. MD; Vajpayee, Rasik B. FRCSEd, FRANZCO

doi: 10.1097/ICO.0b013e3182a27939
Clinical Science

Purpose: To evaluate the structural and functional outcomes of eyes with perforated corneal ulcers undergoing penetrating keratoplasty (PKP) under topical anesthesia.

Methods: A prospective analysis of 17 consecutive cases that underwent PKP under topical anesthesia, where infiltrative anesthesia was contraindicated or general anesthesia could not be given for medical reasons or was not available for logistical reasons.

Results: Seventeen eyes of 15 patients with a mean age of 47.3 ± 16.2 years underwent a PKP for treating perforated corneal ulcers under topical anesthesia. Perforation involved the pupillary zone in 13 (76.5%) cases. Preoperatively, 8 patients (47.1%) were phakic, 8 (47.1%) were pseudophakic, and 1 (5.9%) was aphakic. The PKP was completed successfully in all the eyes. An anterior capsular tear occurred in 3 eyes (17.6%). A posterior chamber intraocular implant was put in 1 eye, and 2 eyes were found to be aphakic. The patients reported mild to moderate discomfort and tolerated the procedure well. At the final follow-up, 10 patients had clear grafts (58.8%), and 7 patients (41.2%) had partially clear grafts. The best-corrected visual acuity was better than 6/18 in 10 eyes and between 6/60 and 6/24 in 7 eyes.

Conclusions: PKP can be performed successfully under topical anesthesia in cooperative patients who have perforated corneal ulcers.

Department of Ophthmology, *Baba Deep Singh Charitable Hospital, Amritsar, Punjab, India;

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; and

Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.

Reprints: Namrata Sharma, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received February 18, 2013

Accepted June 26, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.