Page 53 - NAME OF CONDITION: REFRACTIVE ERRORS

It may be performed in the following conditions
i. Deeper stromal lesions which are non accessible to routine corneal scrapings

ii. Ulcers which show a negative culture, probably because of inadequate specimen.
C) Treatment:

The treatment strategies should be revisited to check for adequacy, appropriateness and
affordability. If the culture grew a different organism, then the treatment regimen should
be modified appropriately as recommended in the previous table. If the ulcers continue to
worsen in spite of correct treatment, then surgical options should be considered.

Surgical Procedure may include:

1. Ulcer Debridement :
 Enhance penetration of topical medication
 Debulking of infective material
2. Tissue adhesive
 Microperforation
 Peripheral corneal ulcer with descematocoele
3. Dacryocystectomy if lacrimal sac infection in same eye

4. Penetrating Keratoplasty

Therapeutic keratoplasty has to be performed when the ulcer progresses despite specific
anti-microbial therapy leading to descemetocele or perforation. The microperforation

could be diagnosed by noticing a decrease in the size of the hypopyon, radial folds from the
base of the ulcer and relief from pain. Sometimes it may seal spontaneously and healing
will be faster. If the anterior chamber is formed within 48 hours with bandage or other
supportive therapy therapeutic keratoplasty could be avoided or postponed. The goals of
the therapeutic keratoplasty are to eliminate the infection and restore the integrity of the
globe. The size of the graft should be decided on the basis of the size of the ulcer and
should include the infected edges. Fresh donor corneas give better results in Phakic eyes.
Steroid in any form should be avoided post operatively in fungal ulcers.

5. Tarsorrhaphy: can be considered in neurotrophic and exposure keratitis

Standard Operating Procedure

a. In Patient

i. Immediate threat to vision
ii. Ulcer involved in the only seeing eye
iii. Pediatric patients needing anesthesia
iv. Impending or actual perforation
v. Any patients requiring surgery
b. Out Patient

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