Hydration of small leaking corneal perforations with cefuroxime

• Published in: International ophthalmology Vol. 39; no. 10; pp. 2401 - 2406
• Main Authors: Allon, Gilad, Shapira, Yinon, Beiran, Itzchak, Blumenthal, Eytan Z.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.10.2019; Springer Nature B.V
• Subjects: Acuity; Adult; Anterior chamber; Anti-Bacterial Agents - therapeutic use; Antibiotics; Cataracts; Cefuroxime; Cefuroxime - therapeutic use; Contact lenses; Contact Lenses, Hydrophilic; Cornea; Corneal Perforation - therapy; Eye; Eye (anatomy); Eye Injuries, Penetrating - therapy; Female; Humans; Hydration; Injections, Intraocular; Male; Medicine; Medicine & Public Health; Ophthalmology; Original Paper; Perforation; Prophylaxis; Retrospective Studies; Saline solutions; Scars; Sealing; Stitches; Surgery; Trauma; Visual acuity; Visual effects; Cefuroxime; Corneal perforation; Corneal scar; Corneal hydration
• ISSN: 0165-5701; 1573-2630
• DOI: 10.1007/s10792-019-01079-8

Purpose To describe a new technique for sealing small corneal perforations after penetrating trauma. Methods Corneal perforations in six eyes were sealed using a stromal cefuroxime hydration technique. This technique is identical to the current method used to seal leaking incisions upon completion of cataract surgery except for the use of cefuroxime instead of balanced salt solution. Additionally, cefuroxime was intentionally injected into the anterior chamber. A therapeutic contact lens was used after the hydration. Comparison was made in eight eyes with small traumatic corneal perforation that was sealed using therapeutic contact lenses without hydration. Results This novel technique was applied in six cases, with leakage stopping immediately following hydration in each of these eyes. In cases presenting with a shallow or flat anterior chamber, this maneuver produced immediate reformation of the chamber. Of note, the corneal scars after hydration were minimal with little effect on visual acuity. When compared to eyes with small corneal perforations which were sealed with therapeutic contact lenses without hydration, all cases that were hydrated with cefuroxime were sealed immediately, as opposed to cases treated without hydration. Furthermore, the eyes that underwent hydration with cefuroxime had a worse average visual acuity on admission, a better average visual acuity 1 month post-trauma, and a shorter average length of hospitalization. Conclusions This new technique offers five major advantages: (1) Immediate sealing of the corneal perforation is achieved. (2) Definitive treatment can be achieved at the slit lamp. (3) Since neither stitches nor glue is applied, healing is achieved with minimal scarring and discomfort. (4) Little equipment is required. (5) Injection of cefuroxime into the anterior chamber provides prophylaxis against infection.