Tenons Patch Graft in the Management of Large Corneal Perforations

Korah, Sanita; Selvin, Satheesh Solomon T; Pradhan, Zia S.; Jacob, Paul; Kuriakose, Thomas

doi:10.1097/ico.0000000000000808

Cited by 42 publications

(30 citation statements)

References 15 publications

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“…Primary TPK is considered the most definitive treatment option for large perforated corneal ulcers regardless of the underlying etiology [8–11], although recently there has been some interest in alternative techniques such as using autologous fibrin membrane combined with solid platelet-rich plasma [17], Tenons patch grafting [18], grafting with processed pericardium combined with synthetic materials [19], and partial thickness lamellar grafting techniques [20]. To our knowledge, this is the first case series to specifically compare long-term outcomes of primary TPK in the setting of sterile versus infectious perforated corneal ulcers in the developed world.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States

Rush

2016

Journal of Ophthalmology

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Purpose. To compare the long-term outcomes of infectious versus sterile perforated corneal ulcers after therapeutic penetrating keratoplasty in the United States. Methods. The charts of 45 consecutive eyes that underwent primary therapeutic penetrating keratoplasty for a perforated corneal ulcer at a single center were retrospectively reviewed. The perforated ulcers were classified as infectious or sterile and the underlying demographics, clinical features, and 36-month outcomes were compared among the two groups. Results. Mean follow-up among subjects was 38.6 (±6.9) months. Patients presenting with sterile perforated ulcers were more likely to have a peripheral perforation location (p = 0.0333) and recurrence of the underlying disease condition (p = 0.0321), require adjunctive surgical measures in the immediate postoperative period (p < 0.0001), have reperforation after keratoplasty (p = 0.0079), have worse best corrected visual acuity (p = 0.0130), develop no light perception vision (p = 0.0053), and require enucleation/evisceration (p = 0.0252) when compared to the infectious perforated ulcer group. Conclusions. Sterile perforated corneal ulcers have a worse prognosis and may be more frequent than those caused by infectious disease in the United States compared to the developing world.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States

Rush

2016

Journal of Ophthalmology

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“…Korah et al described this technique in conjunction with the use of cyanoacrylate glue in 27 cases of corneal perforation of size 3–6 mm. A total of 20/27 patients healed completely with the formation of an adherent leucoma 3. In our case, tenon patch graft was used exclusively to avoid the complications associated with use of tissue adhesives like increased postoperative inflammation, vascularisation and surface irregularity causing ocular discomfort 3.…”

Section: Discussionmentioning

confidence: 88%

“…A total of 20/27 patients healed completely with the formation of an adherent leucoma 3. In our case, tenon patch graft was used exclusively to avoid the complications associated with use of tissue adhesives like increased postoperative inflammation, vascularisation and surface irregularity causing ocular discomfort 3. In addition, it has other advantages like autologous nature of the tissue, minimal postoperative inflammation and rejection, easy availability, cost-effectiveness and a simple surgical technique.…”

Section: Discussionmentioning

confidence: 93%

“…The fistula could have been managed with cyanoacrylate glue with bandaged contact lens; however, it was not available at that moment and the patient could not have afforded it. Moreover, as the photograph suggests, iris tissue could have come directly in contact with glue resulting in severe iritis and intraocular inflammation 3. Also, a donor corneal tissue was not available, so we decided to go ahead with tenon patch graft.…”

Section: Case Presentationmentioning

confidence: 99%

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

Maharana¹,

Singhal

Sahay

et al. 2017

BMJ Case Reports

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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.

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“…However, when the perforation is large, additional graft tissue might be essential for complete closure of the sclerocorneal defect (Korah et al, 2016). Various donor tissues and synthetic materials have been described for reconstructing the ocular surface (Torchia et al, 1968;Koenig et al, 1990;Mauriello and Pokorny, 1993;Mansour and Bashshur, 1999).…”

Section: Discussionmentioning

confidence: 99%

Tenonplasty for closing defects during sclerocorneal surgery—A brief review of its anatomy and clinical applications

et al. 2017

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To provide insight into the clinical anatomy of Tenon's capsule and to describe a technique to manage sclerocorneal defects using autologous Tenon's tissue. A thin layer of Tenon's capsule harvested from the patient's own eye is used to seal the defect and act as a scaffold. The Tenon's flap is spread over the defect and held in place by Vicryl sutures. A bandage contact lens is then placed on the eye. Tenon's capsule is composed of thick fibrous tissue with smooth muscle fibers and a thin posterior capsule of orbital fat. It is rich in fibroblasts, which can accelerate wound healing and eventually lead to robust scarring without risk of immunogenicity and without cost. Tenonplasty uses easily-available autologous Tenon's tissue in patients with sclerocorneal defects to preserve globe morphology. The technique is a feasible alternative not limited by the availability of graft tissue. Clin. Anat. 31:72-76, 2018. © 2017 Wiley Periodicals, Inc.

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Tenons Patch Graft in the Management of Large Corneal Perforations

Abstract: This procedure makes use of easily available autologous Tenons tissue in patients with corneal perforations too large to be managed with cyanoacrylate glue alone, to preserve eyeball morphology. A corneal transplant can then be done when the cornea has healed.

Cited by 42 publications

References 15 publications

Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States

Outcomes of Infectious versus Sterile Perforated Corneal Ulcers after Therapeutic Penetrating Keratoplasty in the United States

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

Tenonplasty for closing defects during sclerocorneal surgery—A brief review of its anatomy and clinical applications

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