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Article
September 1969

PERIPHERAL ISCHEMIC NECROSIS OF THE CORNEA: A NEW THERAPEUTIC APPROACH BASED ON PATHOGENETIC MECHANISMS

Author Affiliations

Nashville, Tenn; San Francisco

Arch Ophthalmol. 1969;82(3):423. doi:10.1001/archopht.1969.00990020425023

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Abstract

To the Editor.  —Peripheral ischemic necrosis, secondary to intravascular clotting of the pericorneal vasculature, appears to be the common, final pathogenetic pathway for a number of described corneal diseases. The various peripheral corneal melting, ulcerative, or abscessed conditions (eg, marginal, furrow, and gutter dystrophy; peripheral ring ulcer or abscess; and, possibly, Mooren's ulcer) comprise a syndromic group we have designated as primary ischemic necrosis of the peripheral cornea. We have described another group as secondary ischemic necrosis which includes those conditions following chemical keratitis, microbialinduced inflammation, retinal detachment surgery, and corneal grafting.To validate ischemic necrosis as the common denominator of these entities, we have treated 19 cases of primary and secondary types with either subconjunctival or systemic heparin. Some cases required adjunctive topical corticosteroid therapy. The results are encouraging in contrast to other recommended modes of management in these conditions (eg, conjunctival flaps, with or without cornea-scleral grafts, and

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