Tenon patch graft for corneal fistula: a rare entity treated by a simple technique

Abstract

A 50-year-old patient presented with dull aching pain with some discomfort in his right eye for the past 2 weeks. History revealed the patient had a past episode of infective keratitis managed medically in a local hospital. The last follow-up record suggested a diagnosis of healed keratitis with corneoiridic scar. On examination, the patient had visual acuity of hand movement and a corneoiridic scar of 7×7 mm with an inferotemporal translucent cystic area measuring 3×4 mm in size with underlying uveal tissue visible. Seidel test was found to be positive confirming leakage. For this, a tenon patch over the area of defect along with anterior chamber formation was done. On postoperative day 1, the graft was well attached and anterior chamber was formed with no leak on Seidel test. Intraocular pressure was 16 mm Hg.

Management of a central corneal perforation in the emergency room: Tenon patch technique

“…Tenon patch grafting has been previously described for the management of scleromalacia after excision of a pterygium, perforation of the scleral perforation and blood leakage from trabeculectomy [7] , [8] . But it has demonstrated its effectiveness in the management of corneal perforations and is increasingly adopted, especially in developing countries without other alternatives in the immediate future [2] , [3] , [9] .…”

“…In our case, the tenon patch was used to avoid the complications associated with perforation as well as the lack of availability of other therapeutic alternatives. In addition, it has other advantages, such as the autologous nature of the tissue and minimal postoperative inflammation [2] . The use of tenon patch grafting has fulfilled all these objectives.…”

“…Therapeutic management must be adequate with the goal of restoring the integrity of the eyeball and thus allowing appropriate healing. The tenon patch graft represents a good alternative to other methods and has many advantages, among which the feasibility in an emergency, allowing a subsequent corneal graft [2] , [3] .…”

Clinical presentation and management of corneal fistula

“…Tenon patch graft has been described previously for the management of scleromalacia after pterygium excision, scleral perforation, leaking trabeculectomy blebs and small corneal perforations 2–8. This technique has also been used successfully in a case of corneal fistula with healed keratitis 3. Various advantages of tenon graft include autologous graft, cost effectiveness, easy availability, minimal postoperative inflammation, vascularisation and surface irregularity as compared with tissue adhesives causing less ocular discomfort.…”

“…The technique is similar to that described earlier by the authors 3. Briefly, the surgical steps included measurement of the size of corneal fistula and surrounding area of thinning using callipers after removing all the necrotic tissue and freshening the edges of perforation.…”