Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States

Abstract

Purpose. To compare the long-term outcomes of infectious versus sterile perforated corneal ulcers after therapeutic penetrating keratoplasty in the United States.Methods. The charts of 45 consecutive eyes that underwent primary therapeutic penetrating keratoplasty for a perforated corneal ulcer at a single center were retrospectively reviewed. The perforated ulcers were classified as infectious or sterile and the underlying demographics, clinical features, and 36-month outcomes were compared among the two groups.Results.Mean follow-up among subjects was 38.6 (±6.9) months. Patients presenting with sterile perforated ulcers were more likely to have a peripheral perforation location (p=0.0333) and recurrence of the underlying disease condition (p=0.0321), require adjunctive surgical measures in the immediate postoperative period (p<0.0001), have reperforation after keratoplasty (p=0.0079), have worse best corrected visual acuity (p=0.0130), develop no light perception vision (p=0.0053), and require enucleation/evisceration (p=0.0252) when compared to the infectious perforated ulcer group.Conclusions. Sterile perforated corneal ulcers have a worse prognosis and may be more frequent than those caused by infectious disease in the United States compared to the developing world.