Open Globe Management

Alessandro A. Castellarin, MD; Dante J. Pieramici, MD

Disclosures

Compr Ophthalmol Update. 2007;8(5):111-124. 

In This Article

Anterior Segment Reconstruction Following Trauma

Indications for keratoplasty following trauma include visually significant astigmatism or opacities that are not amenable to improvement with a contact lens. Superficial scars and fibrovascular pannus may be removed with keratectomy or excimer laser. Penetrating keratoplasty following trauma can be successful, but glaucoma is a frequent complication. Oversizing the donor corneal button steepens the corneal curvature, increasing the iridocorneal space and reducing the incidence of glaucoma.[44]

When severe trauma leads to complete loss of epithelial stem cells, transplantation of autologous cornea stem cell source has been employed along with autologous oral mucosal epithelial cells.[45] Recently, new polymeric materials have allowed replacement of a scarred or diseased cornea. AlphaCor™ (2-hydroxyethyl methacrylate) (CooperVision, Fairport, NY) is a biocompatible artificial cornea designed for corneal blindness not treatable by donor grafting. AlphaCor™ may have a lower incidence of complications than traditional keratoprosthesis and may prove to be preferable to a donor graft in high-risk cases, such as in ocular trauma.[46] Other biomaterials have been employed, such as copolymers of n-butyl methacrylate (BMA) and hexa- (ethylene glycol) methacrylate (HEGMA).[47] Anterior segment membranes can be peeled at the time of transplantation. Lens removal, if required, may be facilitated by the open sky technique. Care should be taken to preserve as much capsule as possible, but if capsular support is not adequate, the lens can be fixated to the iris or to the sclera.

Iridodialysis is usually repaired with iridoplasty with a technique based on the principles of McCannel suture. Aniridia is usually treated with iris print contact lenses or corneal tattooing. There are also several types of iris diaphragms that can be open or closed.

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