Clinical and etiological characteristic, classification and treatment of aseptic corneal ulcers

Introduction. Aseptic corneal ulcers are among rare, but severe, torpid diseases. The aim is to study the etiology, develop a clinical classification of the corneal aseptic ulcer, and determine the tactics of their treatment.

Material and methods. A total of 40 patients (47 eyes) were examined when admitted as emergency with an aseptic ulcer of the cornea. In addition to traditional examination methods, the optical coherence tomography was performed, ulcer area and depth were recorded, and the collagenolytic activity of the tear fluid was also determined. The defect closure with a biological transplant (amniotic membrane preserved in glycerin, allogeneic sclera, self-tissues – a free flap of the sclera or a pedicle flap of the conjunctiva). The procedure was completed by blepharorrhaphy or flap covering with a soft contact lens.

Results. Initial procedures were successful in 34 eyes out of 47 (72.3%). In the remaining 13 cases, repeated surgeries were required: in 11 cases – during first three months, and in 2 cases – between 4 and 12 months. In two patients with high lytic tear activity (more than 700 kU/ml) repeated procedures were performed twice, due to rapid lysis of the amniotic membrane during 14 days.

Conclusion. All patients with a progressive aseptic corneal ulcer need surgical treatment in the form of its coverage with a biological tissue of allo- or autogenous nature. Anterior stromal ulcers should preferably be covered with a free amniotic flap, and the posterior stromal ulcers should be closed with an autoconjunctival-tenon pedicle flap or with a free flap of the sclera. High collagenolytic activity of the tear fluid is the main cause of biological tissue lysis. Primary and repeated plastic surgery allowed a reliable replacement of the corneal ulcer defect area with scar tissue.