SCIENTIFIC REPORT

Choroidal detachment in perforated corneal ulcers: frequency and management

R Singh, T Umapathy, A Abedin, H Eatamadi, S Maharajan and H S Dua

Division of Ophthalmology and Visual Sciences, University of Nottingham, Queens Medical Centre, Nottingham, UK

Correspondence to:
Correspondence to:
Professor H S Dua
Division of Ophthalmology and Visual Sciences, B Floor, Eye ENT Centre, Queens Medical Centre, Nottingham NG7 2UH, UK; harminder.dua{at}nottingham.ac.uk

Aims: To determine the frequency of choroidal detachment (CD) in eyes with non-traumatic corneal ulcer perforation and, also, to assess the efficacy and safety of cyanoacrylate glue in sealing corneal perforations.

Methods: 18 eyes of 17 patients were studied. Inclusion criterion was any patient with a non-traumatic perforated corneal ulcer. All patients had a thorough history taken and complete ophthalmic examination including B-scan ultrasonography. Patient demographics, presence of CD, and efficacy of corneal gluing were assessed.

Results: Eight of the 18 eyes (44%) were documented to have a CD. Among perforations of >2 mm², six eyes (75%) were documented to have CD compared with two eyes (20%) with perforations of 2 mm² (p = 0.054). No correlation could be determined between perforation duration and incidence of CD. Of the 15 eyes that underwent gluing, there were 13 successes (87%) and two failures (13%). Within the successes four patients (27%) required re-gluing because of infection (one patient) or progression of melt and glue loosening (three patients). Failure was the result of severe progression of melting (one patient) and a very large perforation (one patient).

Conclusion: Choroidal detachment following corneal ulcer perforation is common and is more likely in larger corneal perforations. Preoperative B-scan should be considered in cases of large corneal perforations requiring therapeutic keratoplasty to document choroidal detachment, which if large may require drainage. Cyanoacrylate glue is an effective and safe method for sealing small corneal perforations. A vigil must be maintained for infection while the glue and bandage contact lens are in situ.

Abbreviations: AC, anterior chamber; CD, choroidal detachment; EPK, emergency penetrating keratoplasty

Keywords: corneal ulcer; corneal perforation; choroidal detachment; cyanoacrylate glue

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