1
|
Berger T, Flockerzi F, Löw U, Flockerzi E, Aljundi W, Abdin A, Daas L, Seitz B. Corneal Perforation as a Rare and Late Manifestation of Choroidal Melanoma. Klin Monbl Augenheilkd 2023. [PMID: 37224861 DOI: 10.1055/a-2069-2354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To report a case of corneal perforation as a rare and late manifestation of choroidal melanoma and to highlight the major histopathological findings of this unusual combined clinical presentation. METHODS A 74-year-old male patient presented to our department due to corneal perforation of the right eye with the absence of light perception for 6 months. The intraocular pressure was hard on palpation. Because of the protracted finding and reduced visual prognosis, primary enucleation was performed. RESULTS The histopathological examination revealed choroidal melanoma with epithelioid and spindle cell components at the posterior pole, which was positive for Melan-A, Human Melanoma Black 45 (HMB45), BAP1, and SOX10. The anterior segment showed complete anterior chamber hemorrhage and blood remnants in the trabecular meshwork. The cornea displayed diffuse blood staining with hemosiderin and hemosiderin-loaded macrophages and keratocytes. No inflammatory cells were present near the corneal perforation, which had a width of 3 mm. Intraocular heterotopic ossification was indicative of a long-standing condition. Postoperative cancer staging was normal. CONCLUSION Corneal perforation should be considered as a very rare and late manifestation of advanced choroidal melanoma and may result from interaction between intraocular hemorrhage, elevated IOP, and its secondary signs such as corneal blood staining.
Collapse
Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Fidelis Flockerzi
- Institute of General and Special Pathology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Ursula Löw
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Wissam Aljundi
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Alaadin Abdin
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| |
Collapse
|
2
|
Aina AS, Adeleke OT, Aina I. Spontaneous Globe Rupture following Prolonged Uncontrolled Elevated Intraocular Pressure. Middle East Afr J Ophthalmol 2023; 30:125-127. [PMID: 39006925 PMCID: PMC11238936 DOI: 10.4103/meajo.meajo_72_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 07/16/2024] Open
Abstract
We report two glaucoma patients who experienced unusual instances of spontaneous globe rupture. The patients arrived at the Bowen University Teaching Hospital's emergency ophthalmology unit with a history of bleeding from one eye without any history of ocular trauma. They were known glaucoma patients with poor control of their intraocular pressures (IOP). They eventually underwent evisceration shortly after presentation. Spontaneous eyeball rupture in glaucomatous eyes is extremely unusual and has a very poor prognosis for vision. Proper management and appropriate follow-up of glaucoma patients are very important to avert this dreaded complication of uncontrolled IOP.
Collapse
Affiliation(s)
| | - Olumide T Adeleke
- Department of Family Medicine, Bowen University Hospital, Bowen University, Iwo, Osun, Nigeria
| | | |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
Gross AW, Fan JZ, Pfeiffer ML, Chuang AZ, Richani K, Crowell EL. Non-traumatic open globe injuries: presenting characteristics and visual outcomes. Eye (Lond) 2022; 36:2323-2327. [PMID: 34857923 PMCID: PMC9674630 DOI: 10.1038/s41433-021-01869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 11/18/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe clinical characteristics and visual outcomes of non-traumatic open globe injuries. SETTING A level 1 trauma centre in a large urban medical centre. DESIGN Retrospective study. METHODS Charts of non-traumatic open globe patients admitted to MHH-TMC from 1/2010 to 3/2015 were reviewed for demographics, cause, clinical characteristics, visual acuity (VA) and enucleation. RESULTS Thirty eyes were included: 15 (50%) were males with a mean age of 47 (±28) years. All presented with zone 1 injury. Twenty-five (83%) had a perforated corneal ulcer. Presenting VA was count fingers (n = 3, 10%) to NLP (n = 6, 20%). Twenty-four (80%) involved infection, 5 (17%) congenital, 3 (10%) chemical burn and 2 (7%) neurotrophic. Conjunctival injection (n = 22, 77%), corneal opacification (n = 20, 71%) and relative afferent pupillary defect (n = 9, 44%) were common. After treatment, 23 (88%) were worse than 6/60 (20/200), 9 (35%) were NLP and 8 (27%) required enucleation. CONCLUSIONS Often non-traumatic open globe injuries are zone 1 and due to perforated infectious ulcers. Compared to previously reported traumatic injuries, these have higher rates of enucleation (27% vs 8%) and poorer final VA (88% vs 68% worse than 6/60 20/200).
Collapse
Affiliation(s)
- Andrew W Gross
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - James Z Fan
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Margaret L Pfeiffer
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Memorial Hermann-Texas Medical Center, Houston, TX, USA
- Robert Cizik Eye Clinic, Houston, TX, USA
| | - Alice Z Chuang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Karina Richani
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
- Memorial Hermann-Texas Medical Center, Houston, TX, USA
- Robert Cizik Eye Clinic, Houston, TX, USA
| | - Eric L Crowell
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
- Memorial Hermann-Texas Medical Center, Houston, TX, USA.
- Robert Cizik Eye Clinic, Houston, TX, USA.
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW To discuss peripheral ulcerative keratitis, with a focus on the evaluation and management of associated systemic diseases. RECENT FINDINGS Peripheral ulcerative keratitis (PUK) is a sight-threatening condition that is often defined by the presence of a crescent-shaped area of peripheral corneal thinning, an epithelial defect, and an inflammatory corneal infiltrate. It is highly associated with rheumatoid arthritis, systemic necrotizing vasculitides like granulomatosis with polyangiitis, and collagen vascular diseases like systemic lupus erythematosus. Undertreated PUK carries a risk of vision loss and premature death. SUMMARY Multidisciplinary collaboration between the ophthalmologist, rheumatologist, and other consultants is required. Early and aggressive steroid-sparing therapy should be considered in cases due to noninfectious systemic disease.
Collapse
Affiliation(s)
| | - Rex M McCallum
- Department of Medicine, Division of Rheumatology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
6
|
El Halabi M, Seitz B, Quintin A, Suffo S, Flockerzi F, Schlötzer-Schrehardt U, Daas L. [Histoacryl adhesive for acute treatment of corneal penetration in necrotizing herpetic keratitis]. Ophthalmologe 2022; 119:59-64. [PMID: 33296016 PMCID: PMC8763725 DOI: 10.1007/s00347-020-01284-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023]
Affiliation(s)
- M El Halabi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - A Quintin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - S Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - F Flockerzi
- Institut für Pathologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | | | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| |
Collapse
|
7
|
Grusha YO, Ismailova DS, Fettser EI. [Tarsorrhaphy in rehabilitation of patients with thyroid eye disease]. Vestn Oftalmol 2021; 137:47-51. [PMID: 34726857 DOI: 10.17116/oftalma202113705147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the role of tarsorrhaphy and its effectiveness in the treatment of patients with thyroid eye disease (TED). MATERIAL AND METHODS The study identified the patients who required tarsorrhaphy for corneal lesions associated with TED among the total number of 457 patients who underwent tarsorrhaphy at the Research Institute of Eye Diseases over the past 20 years. RESULTS Overall, 477 tarsorrhaphy surgeries (457 patients) were performed, including temporary and permanent, partial and complete. The corneal involvement in TED was the indication for tarsorrhaphy in 81 patients (101 tarsorrhaphies). TED patients were divided depending on the date of operation, and it was found that 61 tarsorrhaphies were performed in the period from 2000 to 2009, and 40 similar interventions were performed in the period from 2010 to 2019. CONCLUSION The reduction in the number of tarsorrhaphy surgeries in patients with TED in the last decade due to improvement of techniques for bony decompression of the orbit and increase in the number of these operations allowed significant reduction of the degree of proptosis and, as a consequence, the exposure surface area of the eye. However, despite all the successes achieved in orbital surgery, tarsorrhaphy still remains an affordable technique that can always be used in case of corneal lesions in thyroid eye disease.
Collapse
Affiliation(s)
- Y O Grusha
- Research Institute of Eye Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - E I Fettser
- Research Institute of Eye Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Tectonic Mini-DSAEK Facilitates Closure of Corneal Perforation in Eyes With Healthy Endothelium. Cornea 2021; 40:790-793. [PMID: 33734161 DOI: 10.1097/ico.0000000000002712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report a surgical technique for closure of a traumatic corneal perforation in a patient with healthy endothelium. METHODS A 69-year-old male patient presented to Southend University Hospital with a 2.5 mm round temporal corneal perforation caused by a metallic foreign body from an industrial accident. Best-corrected visual acuity at presentation was 6/36. The patient received a tectonic small diameter Descemet stripping automated endothelial keratoplasty (mini-DSAEK) to close the perforation. The patient subsequently developed traumatic cataract and underwent cataract surgery 8 months later. Clinical outcomes at 1 week, 1 month, 3 months, 6 months, and 9 months were evaluated. The primary outcomes of interest were successful sustained closure of the perforation and surgical complications, with secondary outcomes of best-spectacle corrected visual acuity (BSCVA, Snellen) and keratometric astigmatism (KA, Pentacam). RESULTS The anterior chamber was reformed by the graft, restoring the globe's mechanical integrity. The bare stroma reepithelized by 1 week. Neither intraoperative nor postoperative surgical complications were reported. The anterior chamber remained deep and formed during subsequent follow-ups through 9 months. At the 9-month follow-up, final best spectacle-corrected visual acuity was 6/6-1 (Snellen fraction). Keratometric astigmatism was 1.1 diopters. CONCLUSIONS Tectonic mini-Descemet stripping automated endothelial keratoplasty is a safe technique in the management of corneal perforations too large for tissue adhesives, with a low astigmatic profile and rapid visual recovery.
Collapse
|
10
|
Cikmazkara I, Selver OB, Palamar M, Egrilmez S, Yagci A. Tectonic Keratoplasty in Patients with Non-traumatic, Non-infectious Corneal Perforations. Open Ophthalmol J 2020. [DOI: 10.2174/1874364102014010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The study aims to report clinical results of tectonic keratoplasty for non-traumatic, non-infectious corneal perforations.
Materials and Methods:
The medical records of 12 patients who underwent tectonic penetrating keratoplasty between October 2014 and August 2018 at Ege University Ophthalmology Department were retrospectively reviewed.
Results:
The mean age of the patients was 52.92±30.34 (range, 2-82) years. The causes of corneal perforation were dry eye (neurotrophic keratopathy (n=4), limbal stem cell deficiency (n=2), exposure keratopathy (n=2) and graft versus host disease (n=1)) in 9 patients. In the remaining 3 patients, the etiology of perforation was not determined. The mean Visual Acuity (VA) was 2.98±0.39 (range, 1.8-3.1) LogMAR before the surgery. Despite conservative treatment, tectonic penetrating keratoplasty had to be performed in all patients in order to manage the perforation. Mean time in between initial examination and surgery was 10.75±12.04 (1-41) days. In 2 patients, allogenic limbal stem cell transplantation; in one patient, lateral tarsorrhaphy and in one patient symblepharon release with amniotic membrane transplantation were performed additional to tectonic keratoplasty. Mean follow-up time was 57.88±55.47 (4-141) weeks. Grafts were clear in 6 eyes and opaque in 5 eyes. The main causes of graft failure among opaque grafts were ocular surface disease (3), allograft rejection (1) and glaucoma-related endothelial failure (1). Phthisis bulbi was detected in one patient with congenital glaucoma due to vitreous loss at the time of perforation. The mean final VA in patients who had clear grafts was 1.83±1.03 (range, 0.8-3.1) LogMAR.
Conclusion:
To prevent serious complications in non-traumatic, non-infectious corneal perforations, providing anatomic integrity immediately is a must. If conservative treatment is inadequate or the perforation area is extensive, tectonic penetrating keratoplasty is indicated. Besides, it is important to manage the etiological risk factors in order to obtain successful clinical follow up.
Collapse
|
11
|
Abstract
Corneal perforation is a potentially devastating complication that can result from numerous conditions that precipitate corneal melting. It is associated with significant morbidity and prompt intervention is necessary to prevent further complications. Causes include microbial keratitis, ocular surface disease, and autoimmune disorders and trauma. Various management options have been described in the literature to facilitate visual rehabilitation. This rview discusses the treatment options that range from temporising measures such as corneal gluing through to corneal transplantation, with decision making guided by the location, size, and underlying aetiology of the perforation.
Collapse
Affiliation(s)
- Rashmi Deshmukh
- Division of Ophthalmology and Visual Sciences, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Louis J Stevenson
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Rasik Vajpayee
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Prevalence and Risk Factors Associated With Corneal Perforation in Chronic Ocular Graft-Versus-Host-Disease. Cornea 2020; 40:877-882. [PMID: 32947414 DOI: 10.1097/ico.0000000000002526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the prevalence and risk factors associated with corneal perforation in patients with chronic ocular graft-versus-host disease (oGVHD). METHODS We reviewed the case records of 405 patients diagnosed with chronic oGVHD over 8 years at a single academic center and assessed the prevalence of corneal perforation in the cohort. We reviewed patient demographics, indication for and type of hematopoietic stem cell transplantation (HSCT), time elapsed between HSCT and perforation, and clinical characteristics including oGVHD severity scores, ocular comorbidities, and topical medications at the time of perforation. Data were analyzed to determine the characteristics of patients with corneal perforation and establish the risk factors. RESULTS Of the 405 patients with chronic oGVHD, 15 (3.7%) developed a corneal perforation. The mean age of patients at the time of perforation was 64 ± 11 years and 10 (67%) were men. The median time to corneal perforation was 3.3 years post-HSCT. Although perforation occurred unilaterally in all cases, 44% had epithelial defects and 38% had stromal abnormalities in the contralateral eye. Of the patients with corneal perforation, 9 (60%) had a National Institute of Health oGVHD severity score of 2 and 6 (40%) had a score of 3. Patients with chronic oGVHD on antiglaucoma drops had a significantly higher risk of corneal perforation (P < 0.001). CONCLUSIONS Corneal perforation is a rare but vision-threatening complication of chronic oGVHD. Our study emphasizes the need for frequent and long-term follow-up of patients with oGVHD regardless of the severity of disease. In particular, patients with chronic oGVHD on topical antiglaucoma medications should be monitored closely due to a higher risk for corneal perforation.
Collapse
|
14
|
Abstract
PURPOSE To report the outcomes of cyanoacrylate tissue adhesive (CTA) application in corneal thinning and perforation. METHODS A retrospective interventional case series of 137 patients receiving CTA for corneal thinning and perforation in 140 eyes between 2001 and 2018 at a single center was reviewed. Success rate and factors associated with glue failure were analyzed. RESULTS Median age of the cohort was 63 years and 69 (50%) were women. One hundred fifteen patients (84%) had at least 1 systemic condition, 46 (34%) had autoimmune diseases. Eighty-nine eyes (64%) presented with perforation and 51 (36%) with thinning. The perforation/thinning was central/paracentral in 82 eyes (59%) and peripheral in 57 eyes (41%). Median size of perforation was 3.1 mm. Causes of perforation and thinning were microbial infection in 75 (55%), sterile melt in 49 (35%), laceration in 10, and keratoprosthesis melt in 8 eyes. Median glue retention was 58 days. Success rate of glue application (defined as intact globe without surgical intervention) was 72%, 61%, and 46% at 10, 30, and 90 days after glue application, respectively. Larger size of perforation/thinning, perforation (vs. thinning), and single glue application (vs. multiple) were correlated with higher failure rate. Systemic conditions, use of topical corticosteroid, etiologies, and location of perforation/thinning were not significantly correlated with glue failure. CONCLUSIONS CTA application was moderately effective in stabilizing corneal perforation and thinning in the very short-term. Multiple applications are often required. Maintenance of globe integrity after glue application decreases with time and the need for surgical intervention remains high.
Collapse
|
15
|
Collagen-Based Fillers as Alternatives to Cyanoacrylate Glue for the Sealing of Large Corneal Perforations. Cornea 2017; 37:609-616. [DOI: 10.1097/ico.0000000000001459] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
16
|
Loya-Garcia D, Serna-Ojeda JC, Pedro-Aguilar L, Jimenez-Corona A, Olivo-Payne A, Graue-Hernandez EO. Non-traumatic corneal perforations: aetiology, treatment and outcomes. Br J Ophthalmol 2016; 101:634-639. [DOI: 10.1136/bjophthalmol-2016-308618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/13/2016] [Accepted: 07/17/2016] [Indexed: 11/04/2022]
|
17
|
Management of inflammatory corneal melt leading to central perforation in children: a retrospective study and review of literature. Eye (Lond) 2016; 30:593-601. [PMID: 26821761 DOI: 10.1038/eye.2015.278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 11/17/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the outcome of early therapeutic penetrating keratoplasty (PKP) for corneal melt leading to perforation in children. METHODS Case notes of all the consecutive patients presenting with acute corneal perforation that underwent urgent therapeutic PKP between 2000 and 2010 to the practice of one of the authors, both NHS at Great Ormond Street Hospital for Children and private, were retrospectively reviewed. Onset of perforation, underlying cause, medical and surgical treatment, pre- and post-operative visual acuity, graft clarity, length of follow-up, and post-operative complications were recorded. RESULTS Four eyes of four consecutive patients (mean age of 9.5 years and median 8.5 years, range 4-17 years) were treated for acquired acute onset corneal perforations. There were three females and one male. Etiologies included herpes simplex keratitis secondary to immune recovery disease post bone marrow transplantation, acanthamoeba keratitis, recessive dystrophic epidermolysis bullosa, and blepharokeratoconjunctivitis with acne rosacea. Pre-operative visual acuity ranged from hand movements to 6/150. All the patients had severe anterior chamber inflammation. All eyes improved in visual acuity ranging from 6/9 to 6/18 with clear grafts at last follow-up. There was no recurrence of melt or perforation. Mean follow-up was 67 months (median 44 months). CONCLUSION PKP during the acute phase together with aggressive medical therapy and close follow-up may achieve good visual outcomes in children with corneal melt with perforation and should be considered. Waiting may sometimes allow the marked inflammatory response seen in children to cause irreversible structural and/or functional damage.
Collapse
|
18
|
González Gomez A, González de Gor Crooke JL, García-Ben A, García-Campos JM. Dellen and corneal perforation after bilateral pterygium excision in a patient with no risk factors. BMJ Case Rep 2015; 2015:bcr-2015-213319. [PMID: 26621907 DOI: 10.1136/bcr-2015-213319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Corneal perforation associated with dellen is a rare but serious complication of a primary pterygium excision. In this case report, we describe a 60-year-old man who underwent a corneal perforation in the centre of corneal dellen in his right eye and corneal dellen in his left eye after the surgical treatment of a bilateral pterygium with a bare sclera technique without adjunctive therapy. He was successfully treated with lamellar keratoplasty in his right eye and a conservative approach in his left eye, consisting of the use of artificial tears, antibiotic ointment and a patch. The clinical evidence from this brief interventional case report indicates that topical lubricants are proper therapy for corneal dellen. However, if corneal perforation is observed, lamellar keratoplasty is a good option.
Collapse
Affiliation(s)
| | | | - Antonio García-Ben
- Department of Ophthalmology, Santiago de Compostela University Medical School, Santiago de Compostela-La Coruña, La Coruña, Spain
| | | |
Collapse
|
19
|
Chen SC, Telinius N, Lin HT, Huang MC, Lin CC, Chou CH, Hjortdal J. Use of Fish Scale-Derived BioCornea to Seal Full-Thickness Corneal Perforations in Pig Models. PLoS One 2015; 10:e0143511. [PMID: 26599018 PMCID: PMC4657996 DOI: 10.1371/journal.pone.0143511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/05/2015] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to test the use of BioCornea, a fish scale-derived collagen matrix for sealing full-thickness corneal perforations in mini-pigs. Two series of experiments were carried out in 8 Lan-Yu and 3 Göttingen mini-pigs, respectively. A 2mm central full thickness corneal perforation was made with surgical scissors and 2mm trephines. The perforations were sealed immediately by suturing BioCornea to the wounded cornea. The conditions of each patched cornea were followed-up daily for 3 or 4 days. Status of operated eyes was assessed with slit lamp examination or optical coherence tomography (OCT). Animals were sacrificed after the study period and the corneas operated were fixated for histological examination. Both OCT imaging and handheld slit lamp observations indicated that a stable ocular integrity of the perforated corneas was maintained, showing no leakage of aqueous humor, normal depth of anterior chamber and only mild swelling of the wounded cornea. Hematoxylin and eosin staining of the patched cornea showed no epithelial ingrowths to the perforated wounds and no severe leucocyte infiltration of the stroma. The fish scale-derived BioCornea is capable to seal full-thickness corneal perforation and stabilize the integrity of ocular anterior chamber in pre-clinic mini-pig models. BioCornea seems to be a safe and effective alternative for emergency treatment of corneal perforations.
Collapse
Affiliation(s)
| | - Niklas Telinius
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
20
|
Bouazza M, Amine Bensemlali A, Elbelhadji M, Benhmidoune L, El Kabli H, El M’daghri N, Soussi Abdallaoui M, Zaghloul K, Amraoui A. Perforations cornéennes non traumatiques : modalités thérapeutiques. J Fr Ophtalmol 2015; 38:395-402. [DOI: 10.1016/j.jfo.2014.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/08/2014] [Accepted: 11/13/2014] [Indexed: 10/23/2022]
|
21
|
Simplified technique for sealing corneal perforations using a fibrin glue-assisted amniotic membrane transplant-plug. Case Rep Ophthalmol Med 2014; 2014:351534. [PMID: 25045563 PMCID: PMC4087251 DOI: 10.1155/2014/351534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/08/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose. To describe a surgical technique using amniotic membrane transplant (AMT) with fibrin glue (FG) for treating smaller corneal perforations more practically and appropriately filling the defect. Method. A patient with noninfectious central corneal perforation, in 1 mm in diameter, was treated with FG-assisted AMT-plug. An AMT was folded in on itself twice by using FG then a small piece of this FG-AMT mixture was cut to maintain an appropriate plug for the site of the corneal perforation. The FG-assisted AMT-plug was placed in the perforation area by using FG. An amniotic membrane patch was placed over the plug, which was then secured by a bandage contact lens. Result. Surgery to restore corneal stromal thickness without recurrence of perforation. Conclusion. The FG-assisted AMT-plug allowed a successful repair of 1 mm in diameter corneal perforation. This technique was easily performed, thus seeming to be a good alternative to treat corneal perforations with restoring corneal thickness.
Collapse
|
22
|
Feliciano-Sánchez A, García-Gil R. [Non-infectious corneal macroperforations treated with a combination of Tachosil(®) and Tutopach(®). A report of 2 cases]. ACTA ACUST UNITED AC 2013; 89:250-3. [PMID: 24269434 DOI: 10.1016/j.oftal.2013.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/09/2013] [Accepted: 05/27/2013] [Indexed: 11/27/2022]
Abstract
CLINICAL CASE We report 2 cases of patients affected by non-infectious corneal macroperforations treated with TachoSil(®) and Tutopach(®), which closed the defect. DISCUSSION This procedure is an excellent choice for the emergency treatment of corneal perforation, especially in those centres that have no other therapeutic options, preserving the eye and visual acuity.
Collapse
Affiliation(s)
- A Feliciano-Sánchez
- Facultativo Especialista Adjunto Oftalmología, Hospital Marina Salud, Denia, Alicante, España
| | - R García-Gil
- Facultativo Especialista Adjunto Oftalmología, Hospital Marina Salud, Denia, Alicante, España.
| |
Collapse
|
23
|
Graue-Hernandez EO, Zuñiga-Gonzalez I, Hernandez-Camarena JC, Jaimes M, Chirinos-Saldaña P, Navas A, Ramirez-Miranda A. Tectonic DSAEK for the Management of Impending Corneal Perforation. Case Rep Ophthalmol Med 2012; 2012:916528. [PMID: 23259100 PMCID: PMC3521400 DOI: 10.1155/2012/916528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/19/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. To report a case of severe corneal thinning secondary to dry eye treated with a tectonic Descemet stripping automated lamellar keratoplasty (DSAEK) and amniotic membrane graft. Methods. A 72-year-old man with a history of long standing diabetes mellitus type 2 and dry eye presented with 80% corneal thinning and edema on the right eye and no signs of infectious disease, initially managed with topical unpreserved lubrication and 20% autologous serum drops. Eight weeks after, the defect advanced in size and depth until Descemetocele was formed. Thereafter, he underwent DSAEK for tectonic purposes. One month after the procedure, the posterior lamellar graft was well adhered but a 4 mm epithelial defect was still present. A multilayered amniotic membrane graft was then performed. Results. Ocular surface healed quickly and reepithelization occurred over a 2-week period. Eight months after, the ocular surface remained stable and structurally adequate. Conclusion. Tectonic DSAEK in conjunction with multilayered amniotic graft may not only provide structural support and avoid corneal perforation, but may also promote reepithelization and ocular surface healing and decrease concomitant inflammation.
Collapse
Affiliation(s)
- Enrique O. Graue-Hernandez
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico
| | - Isaac Zuñiga-Gonzalez
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico
| | - Julio C. Hernandez-Camarena
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico
| | - Martha Jaimes
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico
| | - Patricia Chirinos-Saldaña
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico
| | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico
| | - Arturo Ramirez-Miranda
- Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico
| |
Collapse
|
24
|
Management of Corneal Perforation. Surv Ophthalmol 2011; 56:522-38. [PMID: 22117886 DOI: 10.1016/j.survophthal.2011.06.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/26/2011] [Accepted: 06/07/2011] [Indexed: 12/20/2022]
|
25
|
Abstract
PURPOSE To describe a novel technique for using amniotic membrane in the management of corneal perforations. METHODS Interrupted 10-0 nylon sutures are passed across the perforation site. A roll of amniotic membrane is then placed across the row of preplaced sutures, and the sutures are tied to secure the membrane. An amniotic membrane patch is placed over the graft, which is then protected by a bandage contact lens. RESULTS We illustrate the results of our 2 most recent patients. CONCLUSIONS Amniotic membrane has been widely used in ocular surgery. We recommend the "Swiss roll" amniotic membrane graft technique in cases of severe corneal thinning or localized perforations.
Collapse
|
26
|
Cañones-Zafra R, Benítez-Herreros J, Kubiak K, Montes-Mollón M, Jiménez-Parras R. Perforación corneal no traumática estéril tratada con Tachosil®. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2011; 86:264-6. [PMID: 21821194 DOI: 10.1016/j.oftal.2011.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 02/17/2011] [Accepted: 03/25/2011] [Indexed: 10/26/2022]
|
27
|
Management of Corneal Perforations. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
28
|
Abstract
PURPOSE To report a case of nontraumatic corneal perforation managed with a tectonic drape patch. METHODS Interventional case report. RESULTS A 60-year-old patient with a corneal scar in his left eye likely secondary to herpes simplex virus interstitial keratitis underwent laser peripheral iridotomy for narrow angles. He developed progressive thinning of the cornea overlying the scar that led to a descemetocele and then ultimately a 1.2- × 1.7-mm perforation. Intraoperatively, several attempts were made to seal the perforation with cyanoacrylate glue, but the wound continued to leak. Sterile plastic drape that was on the surgical field was fashioned into a 2-mm-diameter patch, and the peripheral edge of the tectonic drape patch was glued over the perforation, successfully sealing the cornea. One week later, the drape patch was intact without leak, and a penetrating keratoplasty was carried out without complication. CONCLUSIONS Tectonic drape patch technique for nontraumatic corneal perforations in which there is tissue loss is a viable temporizing option when cyanoacrylate glue alone fails and when there is no corneal tissue or amniotic membrane available to close the wound.
Collapse
|
29
|
Clinical Experience With N-Butyl Cyanoacrylate Tissue Adhesive in Corneal Perforations Secondary to Herpetic Keratitis. Cornea 2010; 29:971-5. [DOI: 10.1097/ico.0b013e3181cbfa13] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Vera L, Benzerroug M, Gueudry J, Varin R, Haghighat S, Gérard G, Muraine M. Mise au point sur l’utilisation des colles tissulaires en ophtalmologie. J Fr Ophtalmol 2009; 32:290-305. [DOI: 10.1016/j.jfo.2009.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 01/09/2009] [Indexed: 11/26/2022]
|
31
|
|
32
|
Vasseneix C, Toubeau D, Brasseur G, Muraine M. Prise en charge chirurgicale des perforations cornéennes non traumatiques : étude rétrospective sur 8 ans. J Fr Ophtalmol 2006; 29:751-62. [PMID: 16988625 DOI: 10.1016/s0181-5512(06)73844-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Treatment of nontraumatic corneal perforation is a difficult task. The aim of our study was to retrospectively analyze predisposing conditions leading to perforation, surgical treatments, and visual outcomes. METHODS Fifty-six patients were admitted in our department for a nontraumatic corneal perforation between 1997 and 2004. Mean patient age was 69 years (range, 16-95 years) and the mean follow-up was 20.5 months (range, 6-96 months). RESULTS The diseases associated with perforations were neurotrophic ulcer in 24 cases (43%), peripheral immunologic ulcer in ten cases (18%), dry eye in six cases (11%), and infectious keratitis in seven cases (13%). All patients had specific adapted medical treatment before surgery. As a first procedure, we used cyanoacrylate glue in 14 cases (50% anatomic success), multilayer amniotic membrane transplantation in 23 cases (100% anatomic success), conjunctival flap in six cases, peripheral lamellar graft in three cases (33% anatomic success), emergency penetrating keratoplasty in 13 cases (31% anatomic success), and one patient's eye had to be eviscerated. Several surgical procedures were necessary in 16 cases (28%), nine patients needing total conjunctival flap at the end. We were able to achieve tectonic stability in 91% of eyes and 32% of patients recovered useful visual acuity between 20/400 and 20/50. CONCLUSION Amniotic membrane transplantation is an effective method for managing corneal perforations and usually does not need a further reconstructive procedure. Visual outcome is poor when peripheral or central keratoplasty are needed. We recommend a conjunctival flap when descemetocele or perforation recurs despite previous surgical management.
Collapse
Affiliation(s)
- C Vasseneix
- Service d'Ophtalmologie, Hôpital Charles Nicolle, Rouen
| | | | | | | |
Collapse
|
33
|
Setlik DE, Seldomridge DL, Adelman RA, Semchyshyn TM, Afshari NA. The effectiveness of isobutyl cyanoacrylate tissue adhesive for the treatment of corneal perforations. Am J Ophthalmol 2005; 140:920-1. [PMID: 16310475 DOI: 10.1016/j.ajo.2005.04.062] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 04/26/2005] [Accepted: 04/27/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE To study the results of treatment of corneal perforations with isobutyl cyanoacrylate tissue adhesive. DESIGN Retrospective case series. METHODS The charts of 20 patients (22 eyes) with corneal perforation <or=3 mm in size treated with isobutyl cyanoacrylate tissue adhesive were reviewed for etiology of perforation, visual outcome, and complications. RESULTS Nine of the 22 eyes (40.9%) healed with application of adhesive alone. The mean interval of time needed for healing was 33.4 days. Visual acuity improved in seven eyes (77.8%) and remained stable in two (22.2%). Seven eyes (31.8%) proceeded to penetrating keratoplasty (PK) with the adhesive in place. Of these, visual acuity improved in five (71.4%), remained stable in one (14.3%), and decreased in one (14.3%). Six eyes (27.3%) required more than one application of adhesive. CONCLUSIONS Isobutyl cyanoacrylate tissue adhesive is highly effective at treating corneal perforations. Approximately half of the perforations <or=3 mm healed and visual acuity improved in most of these eyes.
Collapse
Affiliation(s)
- Daria E Setlik
- Duke University Eye Center, Duke University Medical Center, Durham, North Carolina 27705, USA
| | | | | | | | | |
Collapse
|
34
|
Kang PC, Carnahan MA, Wathier M, Grinstaff MW, Kim T. Novel tissue adhesives to secure laser in situ keratomileusis flaps. J Cataract Refract Surg 2005; 31:1208-12. [PMID: 16039499 DOI: 10.1016/j.jcrs.2004.10.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2004] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate 2 novel biodendrimer tissue adhesives in sealing and securing laser in situ keratomileusis (LASIK) flaps. SETTING Duke University Eye Center, Durham, North Carolina, USA. METHODS Laser in situ keratomileusis flaps were created in 10 human eye-bank eyes using the Hansatome microkeratome system (Bausch & Lomb). These eyes were divided into 2 groups. Flaps in the first group (n=4) were secured with a laser-activated biodendrimer adhesive along the flap edge. In the second group (n=6), the flaps were secured with a self-gelling dendritic adhesive. Dry Merocel sponges (Medtronic Solan) were used to test the strength of flap adherence in both groups. Further testing was performed in the second group. The hinges of these flaps were cut with a scalpel blade and fluorescein dye was injected under the flap to observe potential dye leakage along the flap edge. RESULTS Laser in situ keratomileusis flaps sealed with both adhesives were secure with no flap dislocation. There was no leakage of fluorescein dye observed in the second group. Both adhesives were easy to apply, clear when dry, and had a soft rubbery consistency. CONCLUSIONS Two novel biodendrimer adhesives successfully sealed and secured LASIK flaps. These adhesives may prove to be an effective alternative for treating LASIK flap complications such as epithelial ingrowth or flap dislocation.
Collapse
Affiliation(s)
- Paul C Kang
- Duke University Eye Center, Durham, North Carolina 27710, USA
| | | | | | | | | |
Collapse
|
35
|
|
36
|
Goldsmith C, Rene C. Massive spontaneous expulsive suprachoroidal haemorrhage in a blind glaucomatous eye treated with chronic topical steroid. Eye (Lond) 2003; 17:439-40. [PMID: 12724718 DOI: 10.1038/sj.eye.6700372] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
37
|
Miki D, Dastgheib K, Kim T, Pfister-Serres A, Smeds KA, Inoue M, Hatchell DL, Grinstaff MW. A photopolymerized sealant for corneal lacerations. Cornea 2002; 21:393-9. [PMID: 11973389 DOI: 10.1097/00003226-200205000-00012] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether a novel photocrosslinkable polymer synthesized from hyaluronic acid would seal experimental full-thickness corneal lacerations in a rabbit model. METHODS A solution of hyaluronic acid was modified with methacrylate groups (HA-MA), precipitated, dried, reconstituted in an aqueous solution, and sterilized before use. The viscous polymer solution was applied to 38 of 43 experimental corneal lacerations in rabbits and subsequently irradiated with a low-intensity argon laser beam to produce a clear flexible polysaccharide hydrogel patch. The ability of this sealant to repair corneal lacerations was evaluated in four types of full-thickness, 3-mm corneal wounds (linear, linear + epithelium removed, stellate, and stellate + epithelium removed). Slit-lamp examinations, measurements of intraocular pressure, Seidel tests, and histologic studies were performed at selected intervals to evaluate the wound and determine the rate of healing. RESULTS Corneal perforations were completely sealed and the anterior chambers had reformed by 6 hours in HA-MA-treated eyes. There was no evidence of leakage at this or later times in 37 of the 38 eyes. Intraocular pressure had risen to near-normal levels by day 7 in all four groups, and the sealant was still present in most eyes at day 7. In contrast, the anterior chambers did not re-form in control eyes (five) with untreated perforations because of aqueous leakage through the wounds. Minimal inflammation was observed clinically or in histologic sections of treated corneas. There was extensive proliferation of stromal cells and formation of new extracellular matrix at the wound edges, which became tightly adherent between days 4 and 7. CONCLUSION Our novel photocrosslinkable methacrylated hyaluronan polymer sealed 97% (37/38) of the experimental corneal lacerations. HA-MA may prove useful for sealing corneal lacerations in patients and for other sutureless ophthalmic surgical procedures.
Collapse
Affiliation(s)
- Daijiro Miki
- Department of Ophthalmology, Duke Medical Center and Duke University, Durham, NC 27710, USA
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Bruining MJ, Pijpers AP, Kingshott P, Koole LH. Studies on new polymeric biomaterials with tunable hydrophilicity, and their possible utility in corneal repair surgery. Biomaterials 2002; 23:1213-9. [PMID: 11791925 DOI: 10.1016/s0142-9612(01)00237-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A well-known complication in corneal repair surgery is (recurrent) rejection of donor corneal tissue. particularly in patients suffering from an auto-immune disease such as rheumatoid arthritis. Down-regulation of their immune system, by means of drugs, is necessary in order to perform an allograft implantation afterwards. The patient may need a temporary prosthetic cornea while the immune system is inactivated. Recently, NeuroPatch, a mesh-type polyurethane, was used for this purpose. The material exhibits excellent biocompatibility and allows ingrowth of stromal fibroblasts which deposit matrix material into the pores. A serious drawback of NeuroPatch is its non-transparency, which impairs vision. In this work we attempted to develop an improved biomaterial that combines the advantages of NeuroPatch with optical transparency. Based on previous findings that copolymers of hexaethyleneglycolmethacrylate (HEGMA) and butylmethacrylate (BMA), are transparent and well accepted by human corneal epithelial cells, we studied these materials further in detail. (Bruining et al., Bio-Macromolecules 1 (2000) 418) Copolymerizations were studied by means of 1H NMR. The influence of the HEGMA content on hydrophilicity, flexibility and resistance to protein adsorption was studied. The results indicate that materials with a HEGMA content of approximately 20 mol% are potentially useful in corneal repair surgery. These biomaterials meet most of the stringent physical and biological requirements.
Collapse
Affiliation(s)
- Monique J Bruining
- Center for Biomaterials Research, University of Maastricht, The Netherlands
| | | | | | | |
Collapse
|
39
|
Cosar CB, Cohen EJ, Rapuano CJ, Maus M, Penne RP, Flanagan JC, Laibson PR. Tarsorrhaphy: clinical experience from a cornea practice. Cornea 2001; 20:787-91. [PMID: 11685052 DOI: 10.1097/00003226-200111000-00002] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate indications, success rate, and complications of tarsorrhaphy in a cohort of cornea and external disease patients. METHODS In this study, charts of patients who underwent tarsorrhaphies from January 1, 1995, to September 30, 2000, were retrospectively evaluated. Information reviewed included patient age and sex, indication for tarsorrhaphy, duration of signs and symptoms before tarsorrhaphy, time to epithelial healing after tarsorrhaphy, type of tarsorrhaphy (temporary/permanent), complications, timing of tarsorrhaphy removal, recurrence of signs and symptoms after complete or partial opening of the tarsorrhaphy, number of tarsorrhaphies needed to be replaced or extended, and duration of follow up. RESULTS Seventy-seven patients were included in this study. Indications for a tarsorrhaphy were persistent epithelial defects or other ocular surface problems associated with neurotrophic ulcers, penetrating keratoplasty (PK), postinfection, exposure keratopathy, surgery other than PK, dry eye syndrome, radiation keratopathy, ocular cicatricial pemphigoid, Stevens-Johnson syndrome, entropion, and application of tissue adhesive. The epithelial defects in 70 (90.9%) of the 77 eyes completely resolved. Overall, the mean duration of signs and symptoms before tarsorrhaphy was 89.8 +/- 27.8 days, and time-to-healing after tarsorrhaphy was 18.0 +/- 2.0 days. The difference between the duration of the signs and symptoms before tarsorrhaphy and time-to-healing after tarsorrhaphy was statistically significant ( p = 0.01). Of the 77 tarsorrhaphies, 24 (31.2%) were temporary and 53 (68.8%) were permanent. Complications after tarsorrhaphy included trichiasis, adhesion between upper and lower lids after tarsorrhaphy lysis, premature opening of the temporary tarsorrhaphy, pyogenic granuloma, and keloid formation of the eyelid. CONCLUSION Tarsorrhaphy is a very effective and safe procedure in the management of nonhealing epithelial defects and other surface problems, with a 90.9% success rate and only minor complications.
Collapse
Affiliation(s)
- C B Cosar
- Cornea Service, Wills Eye Hospital, Department of Ophthalmology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
| | | | | | | | | | | | | |
Collapse
|