Allogeneic sclera graft combined autologous conjunctival flap for repairing the emergent corneal perforation

Sclera to the Rescue in the Covid-19 Pandemic- Therapeutic Scleral Grafting in Perforated Corneal Ulcers due to Donor Cornea Shortage

“…In case of absolute non-availability of corneal tissue, other surgical measures for corneal perforation in dire contingency include a Gundersen&rsquo's conjunctival flap or a total tarsorrhaphy [7,8]. Though scleral patch grafts are done for various indications, its use in corneal perforation repair is anecdotal [9]. A partial thickness scleral flap from the patient’s own eye has also been described in small peripheral perforations [10].…”

“…These included trephining the final graft from a manually cut large disc of sclera, removal of iris tissue from the sclera, thorough cleaning and irrigating the scleral graft, not attempting to thin out the donor sclera before grafting as a full-thickness closure was needed, tapering of the graft edge to slope for better approximation, leaving the knots exposed but trimmed to prevent cheese wiring due to burying and covering the graft with a conjunctival flap to promote vascularisation. Scleral grafts need to vascularise without which necrosis and infection can occur [9]. As the conjunctiva was boggy, friable, and bleeding to touch, a near-total tarsorrhaphy was done in the other patient.…”