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Kate A, Basu S. Corneal blindness in the developing world: The role of prevention strategies. F1000Res 2024; 12:1309. [PMID: 38618022 PMCID: PMC11009612 DOI: 10.12688/f1000research.141037.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/16/2024] Open
Abstract
Corneal blindness is an important contributor to the burden of global blindness and has a greater prevalence in low-income countries of the developing world where resources and infrastructure are limited. The causes of corneal blindness too are different from high-income countries and include infectious keratitis, ocular trauma, and xerophthalmia. Persons with these indications tend to have unfavourable outcomes after corneal transplantation, limiting their chances of benefitting from this sight-saving procedure. However, most causes of corneal blindness in the developing world are preventable. This highlights the importance of understanding the unique challenges in these regions and the need for targeted interventions. This article discusses various prevention strategies, including primordial, primary, and secondary prevention, aimed at reducing the burden of corneal blindness in low-income countries. These include capacity building, training, and awareness campaigns to reduce the risk factors of ocular trauma, infectious keratitis, and to improve access to first aid. It is also important to promote safe eye practices and tackle nutritional deficiencies through public health interventions and policy changes. Providing the required training to general ophthalmologists in the management of basic corneal surgeries and diseases and enhancing the accessibility of eye care services in rural areas will ensure early treatment and prevent sequelae. Current treatment modalities belong to the tertiary level of prevention and are largely limited to corneal transplantation. In developing nations, there is a scarcity of donor corneal tissue necessitating an urgent expansion of eye banking services. Alternative approaches to corneal transplantation such as 3D printed corneas, cultured stem cells, and biomaterials should also be explored to meet this demand. Thus, there is a need for collaborative efforts between healthcare professionals, policymakers, and communities to implement effective prevention strategies and reduce the prevalence of corneal blindness in the developing world.
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Affiliation(s)
- Anahita Kate
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sayan Basu
- Centre for Ocular Regeneration (CORE), Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Shantilal Shanghvi Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Savastano A, Crincoli E, Rizzo S. Bovine pericardium membrane (TutoPatch) for emergency repair of total corneal melting over an infected corneal graft. Am J Ophthalmol Case Rep 2023; 32:101885. [PMID: 37521803 PMCID: PMC10384563 DOI: 10.1016/j.ajoc.2023.101885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Corneal perforation due to severe melting is a very dangerous, sight-threatening condition requiring immediate management due to the high risk of endophthalmitis and critical hypotony. In the case of perforated corneal grafts, retransplantation is usually postponed to avoid the detrimental effects of inflammation on the new graft. We describe the first case of the use of a TutoPatch graft for emergency replacement of a lamellar graft perforation over acute infectious total melting. Observations A 42-year-old male patient presented to the Emergency Department with pain in the left eye, which was red photophobic. He had been treated with bilateral deep anterior lamellar keratoplasty (DALK) for advanced keratoconus 5 years previously and had been experiencing recurrent corneal ulcers in the left eye within the last 8 months. Clinical examination documented corneal perforation over acute infectious melting involving the total graft surface in the left eye. The infected graft was removed along with the perforated infected residual Descemet membrane, and a double-layer TutoPatch covering was sutured to the host's margin with 10.0 nylon. The covering was left in place for three weeks, allowing the patient to undergo retransplant three weeks later without complications. Conclusions and importance TutoPatch covering can be safely used as an easy-to-preserve emergency material for a temporary bridge to retransplantation in large acute infectious corneal melting.
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Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Emanuele Crincoli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, Créteil, 94100, France
| | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Sharma A, Sharma N, Basu S, Sharma R, Aggarwal S, Gupta PC, Ram J, Nirankari VS. Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions. Clin Ophthalmol 2023; 17:209-223. [PMID: 36685088 PMCID: PMC9851054 DOI: 10.2147/opth.s394454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Corneal perforations are ophthalmological emergencies which can have serious and detrimental consequences, if not managed timely and appropriately. These are a significant cause of ocular morbidity and can result in decreased vision, blindness, and even loss of the eye. Corneal perforations can be managed using a range of treatment approaches, including temporary solutions such as the application of corneal glue and bandage contact lens, as well as definitive treatment such as corneal transplantation. Tissue glues/adhesives were developed as substitutes for sutures in ophthalmic surgery. Unlike sutures, these glues are associated with shorter overall surgical times and reduced inflammation, thus improving postoperative comfort without compromising wound strength. The available tissue adhesives can be broadly classified into two types: synthetic (eg, cyanoacrylate derivatives) and biological (eg, fibrin glue). Cyanoacrylate glue is chiefly used as a corneal patch to manage acute corneal perforations and improve visual outcomes. Fibrin glue can be used instead of cyanoacrylate glue in many conditions with the benefits of reduced conjunctival and corneal inflammation and reaction. Apart from this, each type of adhesive is distinct in terms of its benefits as well as limitations and is accordingly used for different indications. The present review focuses on the two main types of tissue adhesives, their applications in the management of corneal perforations, the associated complications, safety and efficacy data related to their use available in the literature and the need for newer adhesives in this field.
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Affiliation(s)
- Ashok Sharma
- Dr Ashok Sharma Cornea Centre, Chandigarh, UT, India,Correspondence: Ashok Sharma, SCO 2463-2464, Sector 22C, Cornea Service, Dr Ashok Sharma’s Cornea Centre, Chandigarh, 160022, India, Email
| | - Namrata Sharma
- Cornea Service, Dr. R. P. Centre, AIIMS, New Delhi, India
| | - Sayan Basu
- LVPEI Banjara Hills, Hyderabad, Telangana, India
| | - Rajan Sharma
- Dr Ashok Sharma Cornea Centre, Chandigarh, UT, India
| | - Shruti Aggarwal
- Anterior Segment Cataract Surgery, Katzen Eye Group, Baltimore, MD, USA
| | | | - Jagat Ram
- Advanced Eye Centre PGIMER, Chandigarh, UT, India
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Kusumesh R, Ambastha A, Singh A, Kumari D, Mohan N, Sinha BP, Arya LK. Clinical outcome and course of Tenon's patch graft in corneal perforation and descemetocele. Indian J Ophthalmol 2022; 70:4257-4262. [PMID: 36453327 PMCID: PMC9940507 DOI: 10.4103/ijo.ijo_1279_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess the efficacy and clinical outcome of Tenon's patch graft (TPG) in corneal perforation and descemetocele. Methods In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68%) or descemetocele (27, 32%) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS-OCT) were performed on every follow-up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). Results The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow-up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48% and autoimmune disorders in 35% of cases. TPG successfully restored the globe integrity in 74 (87%) eyes (83% in perforation and 96% in descemetocele). Anatomical failure occurred in 11 eyes (13%). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. Conclusion TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS-OCT is a valuable noninvasive tool for monitoring the graft status.
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Affiliation(s)
- Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India,Correspondence to: Dr. Rakhi Kusumesh, Cornea Services, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. E-mail:
| | - Anita Ambastha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ankita Singh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Divya Kumari
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Nilesh Mohan
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti P Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Lalan K Arya
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Corneal stromal repair and regeneration. Prog Retin Eye Res 2022; 91:101090. [DOI: 10.1016/j.preteyeres.2022.101090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/02/2023]
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