PERIOSTEAL GRAFTS IN KERATOMALACIA
H. Mittelviefhaus, C. Auw-Hädrich
In keratomalacia usualy corneal donor tissue or conjunctival flaps are used to cover the corneal ulcer or perforation. Dural tissue grafts were abandoned because of the potential risk of BSE infection. In unfavourable cases which can not be treated by corneal transplantation or if the corneal graft is destroyed by the underlying disease and in which the corneal ulcer can not be covered long enough by a conjunctival flap or by corneal donor tissue, a periosteal graft can preserve the eye. We report our experiences of the treatment of 6 patients.
Patients and Methods: Between Nov. 1996 and Jan. 1998 6 patients received periosteal grafts onto the cornea (age: 59 - 91 years, m=68 years). In one patient a corneal laceration after keratoplasty was unsuccessfully treated by a dural tissue graft. One patient with ocular pemphigoid had bilateral keratomalacia and two unsuccessful corneal transplants on one eye. Two patients had chronic polyarthritis and two patients neuroparalytic corneal ulcers. At the time of surgery the corneal ulcer was perforated in 5 patients. The periosteal grafts were taken from the fossa temporalis or the leteral rim of the orbit. The grafts were sutured onto the cornea by 10-0 nylon sutures and covered by conjunctival tissue.
Results: In all patients the eye could be preserved by the periosteal graft. In one patient the visual acuity improved from perception of handmotion to 1/35. In non of the patients the periasteal tissue was destroyed by the underlying disease. This indicates that corneal and periosteal tissue differs imunologically.
Conclusions: Suturing a periosteal graft onto the cornea is an ultima ratio in the treatment of severe keratomalacia if corneal transplantation or suturing corneal graft tissue onto the ulcer is not possible and if further destruction of corneal tissue has to be expected.
Univ.-Augenklinik Freiburg, Killianstr. 5, D - 79106 Freiburg