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Furundaoturan O, Palamar M, Egrilmez S, Yagci A, Barut Selver O. Patch Transplant in Corneal Perforations: Time, Method, and Cause. EXP CLIN TRANSPLANT 2024; 22:636-640. [PMID: 39254076 DOI: 10.6002/ect.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
OBJECTIVES We present demographic data and clinical features of corneal perforations repaired with patch grafts prepared from residual donor corneal rims. MATERIALS AND METHODS For this retrospective study, we evaluated patients who underwent corneal perforation repair with corneal or corneoscleral patch grafts. We recorded demographic data, as well as perforation cause, examination notes, tissue type-size used, follow-up time, and additional surgeries. Anterior segment photographs were also evaluated. Transplanted tissues were prepared from residual donor corneas used in penetrating keratoplasty and were manually adjusted to the precise size of the wound. RESULTS Fifteen patients were enrolled in the study. Mean age of the patients was 64.9 ± 19.7 years (range, 15-81 years) with a female-to-male ratio of 0.85. The causes of perforation were grouped as inflammation, infection, and trauma. The main indications were inflammation (n = 7; 46.7%) and infection (n = 6; 40%), followed by trauma (n = 2; 13.3%). All patients demonstrated preservation of globe integrity during the follow-up time; however, 1 patient's eye required regrafting with limbal conjunctival excision due to melting and leakage. Three eyes required permanent tarsorrhaphy to control progressive exposure keratopathy, and 2 eyes underwent penetrating keratoplasty to cure scar-related corneal opacity. CONCLUSIONS Patch grafts are effective surgical interventions to assure and maintain globe integrity in corneal perforations. The main advantage seems to be that patch grafting allows special preparations for wound architecture. Moreover, in clinics performing keratoplasty, these patch tissues are readily available.
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Affiliation(s)
- Onur Furundaoturan
- From the Kars Harakani State Hospital, Department of Ophthalmology, Kars, Turkey
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Xiao G, Ben H, Gu S, Hong J. DALK combined intralamellar tectonic patch graft: an alternative approach to treat frank corneal perforation. BMC Ophthalmol 2023; 23:436. [PMID: 37891524 PMCID: PMC10605785 DOI: 10.1186/s12886-023-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Deep anterior lamellar keratoplasty (DALK) has gained popularity in cases of corneal thinning and leaking descemetocele. In this study, we introduced an intralamellar tectonic patch graft in addition to conventional DALK procedures to treat frank cornea perforation. METHODS This retrospective case series included 13 patients (13 eyes) with frank corneal perforations who underwent DALK combined with intralamellar tectonic patch graft between December 2015 and December 2021. In addition to the standard DALK procedure, the perforation site was repaired with an extra intralamellar tectonic patch graft. The collected data included patient demographics, aetiology, size and location of the corneal perforation, visual acuity, surgical details, and postoperative complications. RESULTS Seven patients underwent autologous intralamellar patch grafts, whereas six received allogeneic ones. Anatomical success was achieved in all patients. The mean postoperative follow-up was 33.31 ± 25.96 months (6-73 months). The postoperative visual acuity (0.90 ± 0.65 logMAR) was significantly improved (P = 0.003) compared to the preoperative score (1.74 ± 0.83 logMAR). Best corrected visual acuity (BCVA) improved in 12 eyes (92.3%). The mean endothelial cell density was 2028 ± 463 cells/mm2, 6-12 months postoperatively. There was no recurrence of perforation, and the anterior lamellar graft remained transparent in 12 patients (92.3%). Postoperative complications included epithelial defects (23.1%), ocular hypertension (15.4%), and cataract (7.7%). CONCLUSIONS DALK combined with intralamellar tectonic patch graft may serve as a secure and effective alternative in treating frank corneal perforation, with reduced complications compared to conventional penetrating keratoplasty.
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Affiliation(s)
- Gege Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Hanzhi Ben
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Shaofeng Gu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.
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Fu L, Jones SM. Tectonic mini-Descemet stripping endothelial keratoplasty (mini-DSEK) in the management of corneal perforation secondary to pediatric blepharokerato conjunctivitis. J AAPOS 2023; 27:45-47. [PMID: 36529452 DOI: 10.1016/j.jaapos.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
Abstract
Blepharokeratoconjunctivitis (BKC) in children can have a broad clinical spectrum. Corneal involvement, including perforation, can occur in severe cases. Management aims to restore anatomical integrity and preserve visual function. We report the outcome of a novel technique, tectonic mini-Descemet stripping endothelial keratoplasty (mini-DSEK), to treat a corneal perforation secondary to BKC in a 14-year-old boy after failure to respond to cyanoacrylate glue application and multilayer amniotic membrane patch grafting. On follow-up 8 months postoperatively, the perforation remained sealed, and visual acuity was preserved. The major advantages of this technique are the avoidance of suture-related complications, reduced risk of immunological rejection, minimized postoperative refractive error, and rapid visual rehabilitation.
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Affiliation(s)
- Lanxing Fu
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sophie M Jones
- King's College Hospital NHS Foundation Trust, London, United Kingdom.
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Takahashi S, Ono T, Abe K, Mori Y, Nejima R, Iwasaki T, Miyai T, Miyata K. Prognosis and etiology of traumatic and non-traumatic corneal perforations in a tertiary referral hospital: a 30-year retrospective study. Graefes Arch Clin Exp Ophthalmol 2021; 260:629-635. [PMID: 34468830 DOI: 10.1007/s00417-021-05389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To clarify the prognosis of corneal perforation, we compared the etiology and characteristics of patients with traumatic and non-traumatic corneal perforations. METHODS This retrospective observational study included patients treated for traumatic or non-traumatic corneal perforations at a single tertiary hospital from 1989 to 2019. The variables collected included the primary cause of corneal perforation, final best-corrected visual acuity (BCVA), and treatment administered. The initial treatment administered and treatment success rates were compared between the traumatic and non-traumatic groups. Multivariate linear regression analysis was performed to determine the predictors of final visual acuity. RESULTS Ninety eyes of 90 patients (mean age, 61.1 ± 19.7 years) were included. Traumatic and non-traumatic corneal perforations occurred in 40 (44.4%) and 50 eyes (55.6%), respectively. Among non-traumatic causes, infection and autoimmune disease were the causes for corneal perforation in 18 (20.0%) and 12 eyes (13.3%), respectively. The success rate for the closure of the perforated site with the initial procedure was significantly higher in traumatic corneal perforations than in non-traumatic corneal perforations (90.0% and 72.2%, respectively; p = 0.038). Patients with traumatic corneal perforation had significantly better final BCVA than those with non-traumatic corneal perforation (0.71 ± 1.18 and 1.52 ± 1.12, respectively; p = 0.0016). On multivariate analysis, older age and non-traumatic corneal perforation were significantly related to the final lower BCVA (p < 0.001 and p = 0.029, respectively). CONCLUSION Traumatic corneal perforation demonstrated a significantly better prognosis than non-traumatic corneal perforation. It is critical to consider the primary cause of corneal perforation to anticipate prognosis.
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Affiliation(s)
- Shigefumi Takahashi
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Takashi Ono
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan. .,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan.
| | - Kentaro Abe
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Yosai Mori
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Ryohei Nejima
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Takuya Iwasaki
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Takashi Miyai
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan.,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
| | - Kazunori Miyata
- Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
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Pant OP, Hao JL, Zhou DD, Pant M, Lu CW. Tectonic keratoplasty using small incision lenticule extraction-extracted intrastromal lenticule for corneal lesions. J Int Med Res 2020; 48:300060519897668. [PMID: 31975635 PMCID: PMC7113716 DOI: 10.1177/0300060519897668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective This study investigated an alternative approach for obtaining donor corneas for keratoplasty that can be used in nations with high corneal demand and high costs for treatment of non-healing ulcers or lesions. Methods Eighteen patients (18 eyes) who underwent tectonic keratoplasty using small incision refractive lenticule extraction (SMILE)-extracted lenticule were included. Data were recorded regarding age, corneal status, corneal lesion location and size, preoperative and postoperative visual acuity, lenticule layer, and additional medical history. Results Corneal thinning and corneal perforation in 13 and 5 patients, respectively, were treated with tectonic keratoplasty using SMILE-extracted lenticule. After tectonic keratoplasty, globe integrity was maintained in 16 of the 18 patients. The mean decimal visual acuity improved from 0.2555±0.3326 preoperatively to 0.3303±0.3487 at the final follow-up. Visual acuity improvement was greater in patients with corneal perforation than in patients with corneal thinning. In addition, visual acuity was most improved in patients with infratemporal lesions. Conclusion Tectonic keratoplasty using SMILE-extracted lenticule is a comparatively safe, effective, and reliable alternative approach for the treatment of corneal lesions.
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Affiliation(s)
- Om Prakash Pant
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Ji-Long Hao
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Dan-Dan Zhou
- Department of Radiology, First Hospital of Jilin University, Changchun, China
| | - Manju Pant
- Department of Ophthalmology, Faculty of Medicine, Thamassat University, Rangsit, Thailand
| | - Cheng-Wei Lu
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
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Agarwal R, Nagpal R, Todi V, Sharma N. Descemetocele. Surv Ophthalmol 2020; 66:2-19. [PMID: 33058926 DOI: 10.1016/j.survophthal.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
A corneal descemetocele, the anterior herniation of an intact Descemet membrane through an overlying stromal defect, is a rare, but serious outcome of progressive corneal ulceration and mandates urgent intervention owing to the imminent risk of perforation. Various ocular and systemic abnormalities that can lead to the formation of descemetocele include microbial keratitis, neurotrophic keratopathy, dry eye disorders, and corneal inflammation associated with immune-mediated disorders. The primary aim of management of a descemetocele remains prompt restoration of ocular integrity to prevent the rupture of the Descemet membrane and further complications. Medical therapy is instituted immediately while deciding on the most suitable operative modality for an individual case. Commonly available treatment options include therapeutic bandage contact lenses, tissue adhesives, amniotic membrane transplantation, corneal patch grafts, penetrating or lamellar keratoplasty, and conjunctival flaps. Infrequently, platelet-rich fibrin membrane grafting and umbilical cord patch transplantation have also been tried with success. The surgical strategy and the outcome are commonly determined by the size, location, and etiology of descemetoceles. Despite the availability of all these treatment options, ambiguity remains about management. We review the available literature on pathogenesis, causes, presentation, differential diagnoses, and management of this disorder and also discuss our experience.
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Affiliation(s)
- Rinky Agarwal
- Senior Resident, Cornea, Cataract and Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Ritu Nagpal
- Research Officer, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Vishnu Todi
- Junior Resident, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Namrata Sharma
- Professor of Ophthalmology, Cornea, Cataract and Refractive Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India.
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Rashad R, Weed MC, Quinn N, Chen VM. Extended Wear Bandage Contact Lenses Decrease Pain and Preserve Vision in Patients with Epidermolysis Bullosa: Case Series and Review of Literature. Ocul Immunol Inflamm 2019; 28:379-383. [DOI: 10.1080/09273948.2019.1587472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ramy Rashad
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Nicole Quinn
- New England College of Optometry, Boston, MA, USA
| | - Vicki M. Chen
- Tufts Medical Center, Boston, MA, USA
- New England Eye Center, Boston, MA, USA
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Palioura S, Kymionis G. Corneal neovascularization in childhood keratitis. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sotiria Palioura
- Athens Vision Eye Institute, Cornea Service, Athens, Greece
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - George Kymionis
- Jules Gonin Eye Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Ophthalmology, ‘Gennimatas Hospital’, National and Kapoditrian University of Athens, Athens, Greece
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Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers. J Ophthalmol 2016; 2016:5742346. [PMID: 27830086 PMCID: PMC5086501 DOI: 10.1155/2016/5742346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/26/2016] [Indexed: 12/20/2022] Open
Abstract
Introduction. The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT) in treating nonhealing corneal ulcers. Material and Methods. Eleven patients (11 eyes) with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded. Corneal status was inspected by the laser scanning confocal microscopy and anterior segment optical coherence tomography (AS-OCT). Results. The primary diseases were herpes simplex keratitis (8 eyes), corneal graft ulcer (2 eyes), and Stevens-Johnson syndrome (1 eye). All epithelial flaps were intact following surgery, without shedding or displacement. Mean ulcer healing time was 10.8 ± 3.1 days, with a healing rate of 91%. Vision significantly improved from 1.70 to 0.82 log MAR (P = 0.001). A significant decrease in inflammatory cell infiltration and corneal stromal edema was revealed 2 months postoperatively by confocal microscopy and AS-OCT. Corneal ulcer recurred in 1 eye. None of the patients developed major complications. Conclusion. Active pedicle epithelial flap transposition combined with AMT is a simple and effective treatment for nonhealing corneal ulcers.
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