Treatment of Neurotrophic Ulcers with Conjunctival Flaps

Lugo, Miguel; Arentsen, Juan J.

doi:10.1016/s0002-9394(14)74337-5

Cited by 36 publications

(13 citation statements)

References 2 publications

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“…5 Experimental trials with fibronectin, 6 insulin growth factor, substance P, 7 and nerve growth factor 8 have also been attempted, with limited success. If the defect progresses, surgical treatments such as tissue adhesives, 9 tarsorrhaphy, conjunctival flaps, 10 and penetrating or lamellar keratoplasty 11 if corneal perforation ensues may become necessary. However, these surgical modalities are associated with a large number of problems including tissue inflammation from glue toxicity, diminished vision, and poor cosmesis with a conjunctival flap and tarsorrhaphy and graft failure in the setting of an inflamed or infected eye.…”

mentioning

confidence: 99%

Amniotic Membrane Transplantation and Fibrin Glue in the Management of Corneal Ulcers and Perforations

Hick¹,

Demers²,

Brunette³

et al. 2005

Cornea

158

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mentioning

confidence: 99%

Amniotic Membrane Transplantation and Fibrin Glue in the Management of Corneal Ulcers and Perforations

Hick¹,

Demers²,

Brunette³

et al. 2005

Cornea

158

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“…Current treatments include tears, lubricants, fibronectin,3 4 growth factors,5 and substance P 6. However, if the defect persists even after the application of these treatments and stromal ulcer and thinning develop, surgical treatment such as tissue adhesive,7 contact lens,8 conjunctival flap,9 and tarsorrhaphy10 are often tried. Once a corneal perforation occurs application of glue and/or a penetrating keratoplasty is usually performed to restore the globe integrity.…”

mentioning

confidence: 99%

Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation

Prabhasawat

Tesavibul²,

Komolsuradej³

2001

British Journal of Ophthalmology

159

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Aims-To evaluate the eYcacy of amniotic membrane transplantation (AMT) in persistent corneal epithelial defect with or without stromal thinning and corneal perforation. Methods-28 patients (28 eyes) with persistent corneal epithelial defect unresponsive to medical treatment were given preserved human amniotic membrane transplants. The patients were divided into three groups: group A, persistent corneal epithelial defect 10 eyes; group B, epithelial defect with stromal thinning 13 eyes; and group C, corneal perforation five eyes. AMT was performed using one layer in group A and multilayers in group B and C. The causes of persistent epithelial defect were neurotrophic keratopathy (24 eyes), limbal deficiency (six eyes), exposure keratopathy (four eyes), and Mooren's ulcer (one eye). Results-Success was noted in 82.1% (23/28 eyes) in all groups, with 80% (8/10 eyes), 84.6% (11/13 eyes), and 80% (4/5 eyes) in groups A, B, and C respectively, with a mean follow up of 10.9 months (1-30 months). The mean epithelialisation time after AMT was 2.1 weeks. The healing times of groups B and C are also significantly shorter than group A (p=0.017 and 0.018, respectively). Corneal stromal thickness was significantly increased in all cases in groups B and C (p=0.006). Those with corneal perforation in group C were completely healed by multilayer AMT. There was no diVerence in the epithelialisation time between successful cases treated by a single operation (17 eyes) or repeated operation (six eyes). Vision improved in 18.9% (8/28 eyes) and worsened as a result of cataract formation in 2.3% (1/28 eyes). Failure was noted in 17.9% (5/28 eyes), because of corneal infection (two eyes), neurotrophic keratopathy with and without limbal deficiency (two eyes), and intractable corneal perforation (one eye). No patient developed major immediate postoperative complications or graft rejection.Conclusion-Amniotic membrane can successfully treat refractory corneal epithelial defect by promoting epithelial healing and thus prevent corneal perforation. It can be used as a treatment for corneal perforation by restoring corneal stromal thickness so that emergency penetrating keratoplasty can be avoided.

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“…40 Tarsorraphy and conjunctival flap are effective surgical procedures in promoting corneal healing, but they give poor cosmetic outcome and the visual function is sacrificed. 41,42 Small perforations can be treated with the application of cyanoacrylate glue followed by a soft bandage contact lens. [43][44][45] Larger defects require lamellar or penetrating keratoplasty.…”

Section: Treatmentmentioning

confidence: 99%

Neurotrophic keratitis

Bombardieri

Rama²,

Olzi³

et al. 2003

Eye

325

366

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Neurotrophic keratopathy is a degenerative corneal disease induced by an impairment of trigeminal nerve. Impairment of loss of corneal sensory innervation is responsible for corneal epithelial defects, ulcer, and perforation. In the present report, we reviewed the pathogenesis, diagnosis, and therapeutic aspects of this disease. An accurate history and clinical examination, including the function of cranial nerves, together with the clinical features of the ocular surface are essential for a prompt diagnosis. The evaluation of the corneal sensitivity and tear film function are important diagnostic steps as well. Specific medical and surgical treatments, based on the clinical staging of the disease, are often able to halt its progression. Future developments in the medical treatment including the administration of neuropeptide and growth factors are presented.

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Treatment of Neurotrophic Ulcers with Conjunctival Flaps

Cited by 36 publications

References 2 publications

Amniotic Membrane Transplantation and Fibrin Glue in the Management of Corneal Ulcers and Perforations

Amniotic Membrane Transplantation and Fibrin Glue in the Management of Corneal Ulcers and Perforations

Single and multilayer amniotic membrane transplantation for persistent corneal epithelial defect with and without stromal thinning and perforation

Neurotrophic keratitis

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