Efficacy of Lamellar Keratoplasty with Acellular Porcine Corneal Stroma in Treatment for Infectious Central and Peripheral Corneal Ulcers

Figures & data

Table 1 Baseline characteristics

	Infectious central corneal ulcer group (n=24)	Infectious peripheral corneal ulcer group (n=21)	P
Age (years)	58.4±8.6	58.3±8.7	0.960
Sex (male/female)	12/12	14/7	0.366
Etiology (n)			0.542
Fungus	18	13	__
Virus	2	4	__
Bacteria	4	3	__
Mixed infection	0	1	__
Preoperative complications (n)			>0.999
Glaucoma	1	1	__
BCVA	2.36±1.23	1.53±1.06	0.019
Graft diameter	7.32±0.84	4.64±0.79	<0.0001

Abbreviation: BCVA, best-corrected visual acuity.

Table 2 Comparison of BCVA at different times

	Infectious central corneal ulcer group (n=24)	Infectious peripheral corneal ulcer group (n=21)
Preoperative	2.36±1.23	1.53±1.06
Postoperative 7 days	2.52±0.78	1.70±0.80
Postoperative 1 month	1.63±0.83	1.19±0.71
Postoperative 3 months	1.53±0.78*	0.99±0.64
Postoperative 6 months	1.19±0.75*	0.79±0.61*
Postoperative 12 months	0.61±0.21*	0.76±0.57*

Note: *P<0.05, within-groups difference vs preoperative.

Table 3 Comparison of complications between the two groups

	Infectious central corneal ulcer group (n=24)	Infectious peripheral corneal ulcer group (n=21)	P
Delayed corneal epithelial healing (n)	8	6	0.731
Infection episodes (n)	6	8	0.344
Recurrence of infection (n)	4	0	0.111
Graft melting (n)	6	6	0.787

Figure 1 Images of complete healing of corneal epithelia. (A, B) Epithelial healing at 3 and 7 days after surgery in infectious central corneal ulcers; (C, D)epithelial healing at 3 and 7 days after surgery in infectious peripheral corneal ulcers.

Figure 2 Cases of graft failure. (A–C) Cornea status at preoperation, rejection episode 3 months after APCS transplantation, and after treatment with PKP in infectious central corneal ulcer group. (D–F) Cornea status prior to surgery, at 3 months after APCS transplantation, and after treatment with PKP in infectious peripheral corneal ulcers. APCS, acellular porcine corneal stroma; PKP, penetrating keratoplasty.

Figure 3 Representative images of graft melting. (A) At 4 months, the APCS graft had dissolved, and irreversible turbidity appeared after therapy (B) in the infectious central corneal ulcer grouper group. (C) At 3 months, the APCS graft had dissolved, and was then controlled after therapy (D) in the infectious peripheral corneal ulcer group.

Table 4 Graft-transparency scores at postoperative 12 months

	Infectious central corneal ulcer group (n=24)	Infectious peripheral corneal ulcer group (n=21)	P
0, n (%)	5 (21%)	2 (10%)	__
1, n (%)	8 (33%)	11 (52%)	__
2, n (%)	4 (17%)	4 (19%)	__
3, n (%)	0	0	__
4, n (%)	0	0	__
5, n (%)	0	0	__
Miss, n (%)	7 (29%)	4 (19%)
Total, n (%)	24 (100%)	21 (100%)	0.524

Table 5 Neovascularization scores at postoperative 12 months

	Infectious central corneal ulcer group (n=24)	Infectious peripheral corneal ulcer group (n=21)	P
0, n (%)	14 (58%)	9 (43%)	__
1, n (%)	2 (9%)	3 (14%)	__
2, n (%)	1 (4%)	3 (14%)	__
3, n (%)	0	2 (10%)	__
Miss, n (%)	7 (29%)	4 (19%)
Total, n (%)	24 (100%)	21 (100%)	0.290

Figure 4 Graft-survival rates in the two groups.

Figure 5 Successful graft transplantation in the infectious central corneal ulcer group. (A–D) Before surgery (A) and at 1 day (B), 7 days (C and, D), 1 month (E), 3 months (F), 6 months (G), and 12 months (H) postoperatively.

Figure 6 Another successful graft transplantation in the infectious central corneal ulcer group. (A–D) Before surgery (A) and at 1 day (B), 7 days (C and, D), 1 month (E), 3 months (F), 6 months (G), and 12 months (H) postoperatively.

Figure 7 Successful graft transplantation in the infectious peripheral corneal ulcer group. (A–D) Before surgery (A) and at 1 day (B), 7 days (C and, D), 1 month (E), 3 months (F), 6 months (G), and 12 months (H) postoperatively.

Figure 8 Another successful graft transplantation in the infectious peripheral corneal ulcer group. (A–D) Before surgery (A) and at 1 day (B), 7 days (C and, D), 1 month (E), 3 months (F), 6 months (G), and 12 months (H) postoperatively.