The aim of this study was to explore the therapeutic effect of multi-layer corneal matrix lens implant in the treatment of fungal corneal ulcer complicated with perforation.

The experimental models of corneal ulcer complicated with perforation was built on 5 adult New Zealand white rabbits. The corneal stroma lenticule was collected with femtosecond laser small incision lenticule extraction and bonded with fibrin glue to form a corneal stroma graft. The central part of the corneal stroma graft was drilled with a trephine of appropriate size as a graft, and the graft was used for 10-0 Nylon thread was continuously sutured to the corneal implant bed. After operation, therapeutic contact lens (bandage lens) was worn, and receiving natamycin eye drops one time every 2 hours, levofloxacin eye drops 4 times per day, for 1 month, following up to 3 months. The results of corneal ulcer healing, corneal transparency, reject reaction, and neovascularization growth in corneal stromal grafts after surgery for 3 days, 7 days, 1 month and 3 months were observed. The data were described by using frequency and percentage.

Fungal corneal ulcer occurred in the cornea after 10 days of inoculating Aspergillus fumigatus. Hyphae were found by corneal confocal microscopy or corneal scraping under direct microscopy. After inoculating for 3 days, 5 eyes had corneal graft edema, and no epithelial rejection line, stroma infiltration, or endothelial rejection line appeared, accounting for 100% (5/5) ; 4 eyes corneal graft epithelium was not completely repaired, accounting for 80% (4/5) and 1 eye of the epithelium of the graft was healed, accounting for 20% (1/5); there was no neovascularization; there was no corneal graft infiltration. At 7 days postoperatively, 2 eyes corneal graft epithelial healing, accounting for 40% (2/5); 3 eyes of the epithelium in the central area of the graft was not repaired, accounting for 60% (3/5). After inoculating for one month, 5 eyes had transparent grafts, edema disappeared, no epithelial and endothelial rejection lines, retrocorneal deposits appeared, accounting for 100% (5/5); 1 eye had neovascularization, accounting for 20% (1/5). The chloramphenicol eye drops in conjunctival sac was applied for neovascular eyes 1 to 2 drops every time, 3 to 5 times per day; after treatment the scar was finally healed by vascularization, and no hyphae was found by corneal confocal microscope. After 3 months, 5 eyes of the corneal grafts were transparent, and no rejection occurred, mildly turbid, and no pannus, accounting for 100% (5/5). The time of epithelial regeneration after the corneal stromal grafts transplantation surgery was (16±2) d.

In this study, fibrin glue and multi-layered corneal stromal lens were used to successfully cure the fungal corneal ulcer of white rabbit, which to provide concurrent clinical corneal ulcer perforation disease with potential therapies.