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Otero E, Mercado C. Limbal advancement technique in managing acute or impending peripheral corneal perforations. Am J Ophthalmol Case Rep 2022; 28:101722. [PMID: 36281263 PMCID: PMC9587362 DOI: 10.1016/j.ajoc.2022.101722] [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: 05/02/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To describe the outcomes of a novel technique for the repair of peripheral corneal perforations using autologous limbal tissue. Methods Two patients with peripheral corneal perforations with contraindications to other corneal procedures underwent limbal advancements. This technique involves creating a pedicle of the limbus, sclera and conjunctiva to cover the perforation. Results The tissue had optimal integration in both patients; no aqueous leaks or flat anterior chambers were noted. None of the patients had recurrence of perforation or ocular discomfort. Conclusion In conclusion, this technique is a cost-effective and straightforward alternative for the repair of impending acute peripheral perforations.
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Affiliation(s)
- Ernesto Otero
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia,Corresponding author. Ac. 100 #18A - 51, Bogotá, Colombia.
| | - Carolina Mercado
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia,Corresponding author. Ac. 100 #18A – 51, Bogotá, Colombia.
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Nabih O, Hamdani H, El Maaloum L, Allali B, El Kettani A. Spontaneous corneal perforation complicating ocular rosacea: Case report. Int J Surg Case Rep 2022; 90:106597. [PMID: 34920319 PMCID: PMC8683723 DOI: 10.1016/j.ijscr.2021.106597] [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: 10/15/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Ocular rosacea is a multifactorial disease. Its pathophysiology remains unclear. The ocular manifestations of rosacea are not specific and can range from simple blepharoconjunctivitis to sight-threatening such as corneal perforation. Case report We report the case of a 10-year-old child who presented with a red painful right eye. Based on the clinical findings, we concluded that she had a corneal perforation on ocular rosacea. She benefited from an ipsilateral lamellar autokeratoplasty by lamellar autograft. The evolution was marked by a good healing and a good visual recovery despite a corneal scar. Discussion Ocular rosacea is a multifactorial disease, with an unclear physiopathology. Corneal involvement remains the least common, but the most challenging since serious complications can occur. Corneal perforation is the most severe. Several techniques have been reported and used in the management of corneal perforations such as conjunctival flap, amniotic membrane grafting, and the use of a corneal patch. The later, corneal autografting, remains a simple and effective technique with satisfactory anatomical results. Conclusion Ocular rosacea is a pathology that is still poorly understood and of delayed diagnosis. It can lead to serious vision-threatening complications such as corneal perforation. The corneal patch is a simple, effective and efficient technique that has given good results in our case. Ocular rosacea is a multifactorial disease Various clinical presentation ranging from blepharitis to severe and sight threatening such as corneal perforation Surgical treatment: ipsilateral lamellar autokeratoplasty
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Affiliation(s)
- Omar Nabih
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco.
| | - Hind Hamdani
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
| | - Loubna El Maaloum
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
| | - Bouchra Allali
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
| | - Asmaa El Kettani
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
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Stamate AC, Tătaru CP, Zemba M. Efficacy of conjunctival flap surgery for deep corneal ulcers. Rom J Ophthalmol 2021; 65:171-175. [PMID: 34179583 PMCID: PMC8207872 DOI: 10.22336/rjo.2021.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: To evaluate the clinical efficacy of a selective, partial, pedicle conjunctival flap in the treatment of deep corneal ulcers with or without perforation, resistant to medical treatment. Method: This interventional self-controlled retrospective study included 31 eyes of 31 patients with deep corneal ulcers who underwent conjunctival flap surgery in a tertiary eye care unit between 2017 and 2019. Of these, 9 eyes exhibited corneal perforation. The follow-up period was 12 months. The primary outcome measures were restoring ocular surface integrity and secondary outcome measures were improvement in visual acuity and postoperative complications encountered. Results: Out of the total of 31 patients, 17 patients (55%) were males and 14 patients (45%) were females. The mean age was 56.03 ± 15.46 years. The mean disease duration was 64.10 ± 35.01 days, the mean diameter of the ulcer was 3.61 ± 1.02 mm and the mean depth of the ulcer was 70.65 ± 20.28% of the thickness of the cornea. The etiology was extensive and the corneal ulcers were categorized as infectious (12), noninfectious (16), and unknown (3). An anatomic cure was obtained in 29 (94%) of 31 eyes. Conjunctival flap surgery was unsuccessful in 2 eyes that required evisceration. The postoperative visual acuity (BCVA) improved in 13 (42%) of the 31 eyes, decreased in 9 eyes (29%) and remained unchanged in 9 eyes (29%). The most frequent complications after conjunctival flap surgery were pseudopterygium, cataract and corneal opacity and less frequent complications were glaucoma, astigmatism, flap retraction, corneal perforation and endophthalmitis. Conclusions: Conjunctival flap surgery can successfully treat refractory deep corneal ulcers. It can restore ocular surface integrity and provide metabolic and mechanical support for corneal healing. Also, it can avoid emergency penetrating keratoplasty or create appropriate conditions for a future optic keratoplasty.
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Affiliation(s)
- Alina-Cristina Stamate
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Arena Med Clinic, Bucharest, Romania
| | - Călin Petru Tătaru
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Mihail Zemba
- Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Ophthalmology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
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Chaudhary S, Basu S, Donthineni PR. Long term outcome of Tenon's patch graft in corneal perforation secondary to neurotrophic keratitis: A case report on a 4-year anatomical functional outcome. Int J Surg Case Rep 2021; 83:106046. [PMID: 34098186 PMCID: PMC8188064 DOI: 10.1016/j.ijscr.2021.106046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction This report describes the long-term outcomes of Tenon’s patch graft (TPG) in a corneal perforation secondary to neurotrophic keratitis and outcome of subsequent successful cataract surgery. Presentation of the case A 60-year gentleman presented with a corneal perforation secondary to Herpes Zoster ophthalmicus (HZO). After multiple unsuccessful attempts of cyanoacrylate tissue adhesive application over the perforation, he was referred for a corneal patch graft. Following TPG, he had a tectonically stable cornea that was managed with topical steroids and prophylactic oral Acyclovir. Sequential imaging of the cornea using high-resolution anterior segment- optical coherence tomography (HR-ASOCT) was done to monitor wound healing. Fifteen months later, he underwent uneventful cataract surgery with best-corrected visual acuity improving to 20/30 at 1-month. Discussion Serial imaging of the site of perforation with HR-ASOCT revealed that a fluffy, oedematous TPG in the early postoperative period transitioned into a hyper-reflective, thin, and compact graft over 3-4 months. Despite the corneal thickness at the site of perforation being only 142 μm, the wound had adequate tensile strength to withstand the altered anterior chamber dynamics during phacoemulsification. The resultant translucent nature of the scar provided superior media clarity and better visual outcomes. Conclusion This case demonstrates the efficacy of TPG in acute phase management of corneal perforation following HZO thereby restoring the tensile strength of the cornea, enabling it to withstand the stress of future surgeries like phacoemulsification. Tenon’s patch graft is an effective technique in managing corneal perforations. It is both easily accessible and economical. Resultant thin scar has adequate strength to withstand intraocular procedures.
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Affiliation(s)
- Simmy Chaudhary
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India; Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, India
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Bafna RK, Kalra N, Asif MI, Agarwal R, Lata S, Titiyal JS, Sharma N, Vikas SJ. Novel technique of tetra trephination for elliptical-shaped tectonic patch grafts in peripheral sterile keratolysis. Eur J Ophthalmol 2021; 31:2769-2775. [PMID: 33685255 DOI: 10.1177/1120672121998955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a novel technique of tectonic patch grafts for elliptical-shaped peripheral sterile keratolysis with iris prolapse. METHODS We performed a full thickness corneo-scleral patch graft in five eyes of five patients with elliptical-shaped peripheral sterile keratolysis with perforation and iris tissue prolapse. In this technique, four disposable trephines with predetermined diameter were employed to fashion both the host and the donor without any free-hand dissection. An intact anatomical integrity of the globe without the need for any repeat tectonic measures was considered as a successful outcome. RESULTS The mean age was 34.2 ± 10.2 years (18-45). The mean total surgical time and donor preparation time was 94.4 ± 7.12 min and 7.6 ± 1.14 min, respectively. The intraoperative course was uneventful in all cases and all eyes had a well-maintained corneal integrity till 6 months follow up. CONCLUSION We describe a simple, reproducible, and time-saving technique of performing elliptical shaped corneoscleral patch grafts for peripheral corneal perforations with iris prolapse.
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Affiliation(s)
- Rahul Kumar Bafna
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Kalra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rinky Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Lata
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan Singh Titiyal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Jee Vikas
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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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.
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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
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Zemba M, Stamate AC, Tataru CP, Branisteanu DC, Balta F. Conjunctival flap surgery in the management of ocular surface disease (Review). Exp Ther Med 2020; 20:3412-3416. [PMID: 32905115 PMCID: PMC7465514 DOI: 10.3892/etm.2020.8964] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
Literature regarding conjunctival flap surgery was reviewed to describe and discuss the rationale for this type of procedure. The conjunctival flap is an acknowledged surgery for the treatment of various corneal diseases with a chronically compromised ocular surface, such as severe dry eye, neurotrophic or neuroparalytic disease, or bullous keratopathy. The purpose of this surgery is to restore the integrity of the corneal surface and thus to prevent gradual corneal ulceration and secondary infection, as well as to ameliorate pain, reduce the need for frequent medications, improve cosmetic appearance, and offer an alternative to invasive surgery or enucleation. Since the introduction of more effective methods of treating severe ocular surface diseases, conjunctival flap surgery has rarely been the primary modality of treatment and has usually followed a range of medical and surgical treatments. The availability of improved ocular lubricants, more effective antimicrobials, bandage contact lenses, tissue adhesives, and other corneal and conjunctival surgical interventions, has reduced the need for conjunctival flaps. However, conjunctival flaps remain extremely useful in selected cases and deserve a place in the ophthalmologist's repertoire for the management of ocular surface disease.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Alina-Cristina Stamate
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Calin Petru Tataru
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
| | | | - Florian Balta
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, Bucharest 050474, Romania
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Application of the SMILE-derived lenticule in therapeutic keratoplasty. Int Ophthalmol 2019; 40:689-695. [PMID: 31754892 DOI: 10.1007/s10792-019-01229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To observe the clinical efficacy of the small incision lenticule extraction (SMILE)-derived lenticule patch graft in therapeutic keratoplasty, especially for the treatment of corneal microperforation or partial-thickness corneal defects. METHODS Corneal lenticule obtained from SMILE surgery with diameter greater than 6.5 mm and thickness greater than 100 μm was preserved in a balanced salt solution (Alcon Laboratories, Fort Worth, TX) containing 50 mg/mL penicillin, 50 mg/mL streptomycin, 100 mg/mL neomycin, and 2.5 mg/mL amphotericin for at least 3 months. Preoperatively, anterior segment optical coherence tomography was used to assess the depth of the ulcer and to decide the thickness of the lenticule. Patients were followed up on day 1 and then at 1, 3, and 6 months postoperatively. RESULTS Corneal perforation or defects were successfully patched in all 17 eyes; 8 eyes (47%) exhibited improvement postoperative corrected distance visual acuity. During the follow-up period of 6 months, there was no evidence of infection, relapse, or perforation detected in all eyes. Lenticule grafts were attached by graft beds very well and remain clear through to the last follow-up checkup in all eyes treated. CONCLUSIONS The lenticule patch graft seems to serve as a safe, feasible, and inexpensive surgical option for the treatment of keratohelcosis or partial-thickness corneal defects, especially in small perforation and defects. There are hopeful signs that SMILE-derived lenticule becomes a potential graft for therapeutic keratoplasty.
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Dua HS, Said DG, Messmer EM, Rolando M, Benitez-del-Castillo JM, Hossain PN, Shortt AJ, Geerling G, Nubile M, Figueiredo FC, Rauz S, Mastropasqua L, Rama P, Baudouin C. Neurotrophic keratopathy. Prog Retin Eye Res 2018; 66:107-131. [DOI: 10.1016/j.preteyeres.2018.04.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 01/09/2023]
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Nizeyimana H, Zhou DD, Liu XF, Pan XT, Liu C, Lu CW, Hao JL. Clinical efficacy of conjunctival flap surgery in the treatment of refractory fungal keratitis. Exp Ther Med 2017; 14:1109-1113. [PMID: 28810564 PMCID: PMC5525570 DOI: 10.3892/etm.2017.4605] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
The aim of the present study was to investigate the use and effectiveness of a selective, partial, pedunculated (tongue-shaped) conjunctival flap (CF) for the treatment of refractory fungal keratitis (FK) with or without perforation. A total of 31 cases of corneal diseases treated by CF surgery between April 2014 and October 2015 were evaluated. Among the 31 cases, 16 cases (male:female, 11:5) with FK were selected. Logistic regression analysis was used to investigate factors associated with complications of CF surgery. A higher prevalence of FK was identified among male farmers compared with female farmers, in which plant trauma was the most prevalent cause of the disease. Only 4 patients had experienced corneal perforation prior to CF surgery. Patients aged 61–80 years had a higher prevalence of FK (50%) compared with other age groups; however, there was no statistically significant correlation between the prevalence of FK and sex or age. It was also demonstrated that age, sex, combined surgery and surgery duration were not significantly associated with post-surgical complications. All CF surgeries were performed following corneal ulcer scraping; however, 4 patients (12.5%) required additional surgery. The visual acuity of participants post-surgery decreased in 4 cases and remained unchanged in 12 cases. A total of 3 study patients experienced post-surgical complications of corneal perforation (1 patient) and purulent exudate spreading (2 patients). The post-surgical outcome was good for all study participants as the surgeries were able to control infection and preserve the eyeball, with the potential of future corneal transplant. These results suggest that CF surgery may be a useful alternative treatment for refractory FK in countries such as China where there is lack of cornea donors.
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Affiliation(s)
- Honorine Nizeyimana
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Dan-Dan Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiu-Fen Liu
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiao-Tao Pan
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Cong Liu
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Cheng-Wei Lu
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ji-Long Hao
- Department of Ophthalmology, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Abd Elaziz MS, Zaky AG, El SaebaySarhan AR. Stromal lenticule transplantation for management of corneal perforations; one year results. Graefes Arch Clin Exp Ophthalmol 2017; 255:1179-1184. [PMID: 28409225 DOI: 10.1007/s00417-017-3645-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/05/2017] [Accepted: 03/20/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To study application of stromal lenticules extracted by femtolaser small incision lenticule extraction (SMILE) surgery as a surgical adjuvant to seal corneal perforations. METHODS Corneal stromal lenticules obtained through SMILE surgery with central thickness 100 μm or more were fixed over corneal perforation sites using 10-0 nylon interrupted stitches with an overlying single layer of amniotic membrane. Seven patients who had been followed up for a minimum of 12 months were assessed using slit-lamp biomicroscopy, fluorescein stain, tonometry, and best spectacle-corrected visual acuity (BSCVA) measurements. Postoperative complications were recorded throughout the follow up period. RESULTS Corneal perforations had successfully been sealed in all 7 patients; 3 patients (42.9%) exhibited improved postoperative BSCVA. During the follow-up period of one year, no signs of re-perforation or infections were detected in any patient. CONCLUSIONS These early findings suggest that the use of corneal stromal lenticules could be a safe and efficient surgical adjuvant for corneal perforation closure with potential clinical application, together with amniotic membrane, as relatively simple and low cost temporary measures to prepare perforated corneas for further definitive procedures.
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Affiliation(s)
| | - Adel Galal Zaky
- Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Al-Amry MA, Al-Ghadeer HA. Ocular acne rosacea in tertiary eye center in Saudi Arabia. Int Ophthalmol 2016; 38:59-65. [DOI: 10.1007/s10792-016-0420-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 12/22/2016] [Indexed: 12/28/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the options for, and recent developments in, the surgical treatment of corneal infections. Although the mainstay of treatment of corneal infections is topical antimicrobial agents, surgical intervention may be necessary in a number of cases. These include advanced disease at presentation, resistant infections, and progressive ulceration despite appropriate treatment. Prompt and appropriate treatment can make the difference between a good outcome and loss of vision or the eye. RECENT FINDINGS There are a number of surgical therapies available for corneal infections. Preferred therapeutic modalities differ based on the size, causation, and location of the infection but consist of either replacement of the infected tissue or structural support of the tissue to allow healing. Although there are no completely novel therapies that have been developed recently, there have been incremental improvements in the existing treatment modalities making them more effective, easier, and safer. SUMMARY Several options are available for surgically managing corneal infections. Ophthalmologists should select the optimal procedure based on the individual patient's situation. VIDEO ABSTRACT http://links.lww.com/COOP/A20.
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Affiliation(s)
- Sonal Tuli
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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Nawani N, Vazirani J, Ojha H, Sangwan VS. Conjunctival pedicle flap in management of open globe injury with corneal tissue loss. BMJ Case Rep 2016; 2016:bcr-2015-213703. [PMID: 26976834 DOI: 10.1136/bcr-2015-213703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Accidental injury with scissors led to an open globe injury with iris prolapse and corneal tissue loss in the right eye of a 15-year-old girl. Attempts to suture the laceration normally, led to persistent aqueous leak, and tight suturing was leading to unacceptable distortion of the corneal contour. In the absence of donor tissue or tissue glue, a bulbar conjunctival pedicle flap was used to augment sutures placed without undue tension, and watertight closure of the globe was achieved. Postoperatively, the flap retracted, and excellent tectonic, cosmetic and refractive outcomes were achieved. A conjunctival pedicle flap can be a useful adjunct in the armamentarium of the corneal surgeon while dealing with open globe injuries with corneal tissue loss.
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Affiliation(s)
| | - Jayesh Vazirani
- Cornea and Anterior Segment Service, Maheshwari Eye Care Hospital, Rajkot, Gujarat, India
| | - Hindukush Ojha
- Cornea and Anterior Segment Service, Nethra Jivan Eye Hospital, Dehradun, Uttarakhand, India
| | - Virender S Sangwan
- Centre for Ocular Regeneration, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Khater MM, El-Shorbagy MS, Selima AA. Argon laser photocoagulation versus intrastromal voriconazole injection in treatment of mycotic keratitis. Int J Ophthalmol 2016; 9:225-9. [PMID: 26949639 DOI: 10.18240/ijo.2016.02.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare argon laser photocoagulation and intrastromal injection of voriconazole as adjunctive treatment modalities in cases of resistant mycotic corneal ulcers. METHODS Two groups each of them included 20 cases of resistant mycotic corneal ulcers. Both groups treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity results. In one group argon laser photocoagulation was used as an adjunctive therapy to the specific antifungal drugs and in the other group, intrastromal injection of voriconazole was done besides the specific antifungal drugs. The 40 cases included in the study were proven according to culture and sensitivity to be 28 cases with pure fungal results and 12 cases with mixed (fungal and bacterial). In argon laser group, argon laser irradiation of the corneal ulcer was performed using argon laser 532 nm wavelength (Carl Zeiss LSL 532s AG; Meditec, Inc.) after fluorescein staining. In the other group, voriconazole solution (500 µg/mL) was prepared and injected in the corneal stroma. All cases were followed up for 3mo after healing was achieved. RESULTS Complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects were achieved in argon laser group in duration ranged from 2-4wk in 90% of cases. In voriconazole group 4 cases needed amniotic membrane graft due to thinning and 16 cases healed in duration ranged from 2-6wk (80% of cases). CONCLUSION Argon laser photocoagulation is superior to intrastromal voriconazole injection in treatment of resistant fungal corneal ulcers.
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Affiliation(s)
- Mohammad M Khater
- Department of Ophthalmology, Tanta University Hospital, Tanta 31111, Gharbia governorate, Egypt
| | - Mohammad S El-Shorbagy
- Department of Ophthalmology, Tanta University Hospital, Tanta 31111, Gharbia governorate, Egypt
| | - Adel A Selima
- Department of Ophthalmology, Tanta University Hospital, Tanta 31111, Gharbia governorate, Egypt
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Treatment of corneal perforation with lenticules from small incision lenticule extraction surgery: a preliminary study of 6 patients. Cornea 2015; 34:658-63. [PMID: 25811718 DOI: 10.1097/ico.0000000000000397] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the use of lenticules extracted using small incision lenticule extraction (SMILE) surgery as a surgical alternative for wound closure in corneal perforation. METHODS Corneal lenticules obtained through SMILE surgery with central thickness >100 μm were fixed over corneal perforation sites using 10-0 nylon interrupted stitches. Patients were monitored for a minimum of 1 year and were assessed using slit-lamp microscopy, fluorescein, digital tonometry, and best spectacle-corrected visual acuity (BSCVA) measurements. Postoperative complications throughout the study period were recorded. RESULTS Corneal perforations were successfully sealed in all 6 patients; 3 patients (50%) exhibited improved postoperative BSCVA. Between 3 and 4 weeks after the operation, part of the lenticules became incorporated into the corneal stroma and complete reepithelialization was achieved. During the follow-up period of 12 months, no evidence of infection, relapse, or perforation was detected in any patient. CONCLUSIONS These preliminary findings suggest that the use of corneal lenticules may be a safe and effective surgical alternative for corneal perforation closure, with potential clinical application as relatively simple and inexpensive temporary measures to improve the condition of the cornea for further definitive interventions.
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Khater MM, Selima AA, El-Shorbagy MS. Role of argon laser as an adjunctive therapy for treatment of resistant infected corneal ulcers. Clin Ophthalmol 2014; 8:1025-30. [PMID: 24920878 PMCID: PMC4043817 DOI: 10.2147/opth.s59928] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of argon laser as an adjunctive therapy in ten patients with resistant infected corneal ulcers with or without hypopyon. Methods The study included 20 patients, split into two groups of ten, with resistant infected corneal ulcers with or without hypopyon. One group was considered as the control group and treated with local and systemic specific antimicrobial drugs guided with culture and sensitivity tests. The other group started with the same specific therapy as the control group for 1 week with no obvious improvement and then was further treated with argon laser. The ten patients in the control group included five cases of fungal ulcers, three mixed (fungal and bacterial) ulcers, and two viral ulcers. The ten patients in the other group included three cases of fungal ulcers, three mixed (fungal and viral) ulcers, three viral ulcers, and one bacterial ulcer as proven with microbial culture and sensitivity tests. Eight cases of the control group and seven cases of the other group were associated with hypopyon. Before laser treatment, a drop of benoxinate hydrochloride 0.4% and a single drop of fluorescein sodium 0.25% were instilled. Argon laser irradiation of the affected cornea was performed using an argon 532 nm wavelength (Carl Zeiss LSL 532s AG; Carl Zeiss Meditec AG, Jena, Germany). A spot size of 500 μm, pulse duration of 0.2 seconds, and power of 900 mW were used. All cases were followed up for 3 months after healing was achieved. Results During the first 4 weeks after laser treatment, all patients showed complete healing of the epithelial defect and resolution of stromal infiltration with no adverse effects. In the control group, four cases needed an amniotic membrane graft due to thinning and the other six cases were healed in a duration that ranged from 3 to 7 weeks. Conclusion Argon laser phototherapy is useful as an adjunctive treatment for resistant infected corneal ulcers. More cases are needed to get more reliable results and to confirm our findings.
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Affiliation(s)
| | - Adel A Selima
- Ophthalmology Department, Tanta University, Tanta, Egypt
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Sharma A, Mohan K, Sharma R, Nirankari VS. Repositioning of pedicle conjunctival flap performed for refractory corneal ulcer. Middle East Afr J Ophthalmol 2014; 21:89-91. [PMID: 24669154 PMCID: PMC3959050 DOI: 10.4103/0974-9233.124118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 50-year-old male was referred with a previous history of conjunctival flap (CF) for a nonhealing fungal corneal ulcer with extreme corneal thinning in the right eye. The peritomy for the CF extended from 6:30 to 9:30 clock h on the cornea. The CF was disengaged, peritomy area deepithelialized, and CF was repositioned. He later underwent penetrating keratoplasty and achieved 20/40 best corrected visual acuity. The authors present a new concept for surgically repositioning CF s to the original site immediately after healing of the corneal ulcer.
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Affiliation(s)
| | | | - Rajan Sharma
- MM Institute of Medical Sciences and Research Mullana, Ambala, Haryana, India
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Yalniz-Akkaya Z, Burcu A, Doğan E, Onat M, Ornek F. Therapeutic penetrating keratoplasty for infectious and non-infectious corneal ulcers. Int Ophthalmol 2014; 35:193-200. [PMID: 24652460 DOI: 10.1007/s10792-014-9931-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/03/2014] [Indexed: 11/25/2022]
Abstract
This study reports the outcomes of therapeutic penetrating keratoplasties, defined as keratoplasties performed to eradicate active infectious corneal diseases or to repair a structural defect of the cornea. The records of 24 eyes of 24 patients (17 female and 7 male) treated with therapeutic penetrating keratoplasty between 2002 and 2010 were evaluated retrospectively. Patients were divided into infectious keratitis group and non-infectious keratitis group. The mean age was 52.12 ± 17.91 years. The median follow-up time was 22 months (min-max: 6-96). Therapeutic success was achieved and eyes were preserved in 23 patients and one patient required evisceration for recurrent fungal infection. At the end of the follow-up period, 92.9 % (n = 13) and 77.8 % (n = 7) of grafts remained clear in the infectious and non-infectious groups, respectively (p = 0.538). Visual acuity (VA) improved at least one Snellen line in 23 patients. The mean postoperative decimal VA was 0.2 ± 0.3 and 0.1 ± 0.3 in the infectious and non-infectious groups, respectively (p = 0.12). Amniotic membrane transplantation was performed in two eyes preoperatively and in four eyes postoperatively. Therapeutic penetrating keratoplasty continues to be an effective method in the treatment process of serious perforated and non-perforated corneal infectious and non-infectious diseases resistant to medical and other surgical interventions.
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Affiliation(s)
- Zuleyha Yalniz-Akkaya
- Ankara Training and Research Hospital, Sukriye Mah. Ulucanlar Cad. No:89, Altındag, 06230, Ankara, Turkey,
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Vieira AC, Mannis MJ. Ocular rosacea: common and commonly missed. J Am Acad Dermatol 2014; 69:S36-41. [PMID: 24229635 DOI: 10.1016/j.jaad.2013.04.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 04/21/2013] [Indexed: 12/23/2022]
Abstract
Rosacea is a prevalent disorder that may be disfiguring and cause significant ocular morbidity, if not diagnosed and managed appropriately. Ocular rosacea, in particular, is often left undiagnosed as no specific test is available to confirm the diagnosis. Accurate diagnosis is further complicated because symptoms of ocular rosacea are not always specific to the disorder alone. Other ophthalmic disorders may present with similar findings. Further challenges exist because the severity of ocular symptoms is often not related to the severity of cutaneous findings in rosacea. Isolating a disease marker may facilitate earlier diagnosis and treatment, and could also contribute to better understanding of disease pathogenesis. The glycomics of tear fluid and saliva in patients with rosacea shows promise as an initial step in the search for a biomarker specific to the disease. We have previously found potentially important disease biomarkers in roseatic tear and saliva samples. Further investigation should prove important in the early stages of developing a set of markers for accurate disease identification.
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Lee DI, Kim KW, Kim JC. A Case of Autologous Tragal Perichondrium Graft in a Patient with Mooren's Ulcer. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.3.437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Ik Lee
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae Chan Kim
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea
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Lin HC, Lee YS, Chia JH. Management of Rheumatoid Arthritis-Related Peripheral Ulcerative Keratitis Using Glycerol-Preserved Corneas. Asia Pac J Ophthalmol (Phila) 2013; 2:291-4. [PMID: 26107031 DOI: 10.1097/apo.0b013e318299868e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to report the surgical outcome of patch grafts using glycerol-preserved corneas in perforated or near-perforated rheumatoid arthritis-related peripheral ulcerative keratitis (PUK). DESIGN This is a retrospective chart review of a case series. METHODS The medical records at a single institution were reviewed between July 2004 and July 2011. Of the 19 patients with PUK, 7 (36.8%) underwent glycerol-preserved cornea patch grafts for rheumatoid arthritis-related PUK. The clinical features, precipitating factors, adjuvant therapy, and therapeutic outcomes were analyzed. RESULTS The age of patients ranged from 49 to 82 years (mean [SD], 64.43 [13.53] years) for the 4 women and 3 men with perforated or near-perforated PUK who were managed with systemic and local immunosuppressive therapy. A wound culture revealed 1 Staphylococcus aureus and 1 filamentary fungal infection. The mean (SD) area of the graft was 13.28 (6.11) mm; the mean (SD) time to reepithelializaiton was 7.0 (1.60) days. One patient had high intraocular pressure managed by topical medication; another had a complicated cataract formation. One graft melting was successfully managed by topical and systemic medication. CONCLUSIONS Glycerol-preserved cornea patch grafts were successful in all patients and may be a viable option in perforated or near-perforated PUK, particularly when fresh donor corneas are neither available nor indicted.
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Affiliation(s)
- Hsin-Chiung Lin
- From the Departments of *Ophthalmology, and †Medical Biotechnology and Laboratory Science, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Stromal Melting Associated With a Cosmetic Contact Lens Over a Boston Keratoprosthesis. Eye Contact Lens 2013; 39:e4-6. [DOI: 10.1097/icl.0b013e31824daad2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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]
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Abstract
Rosacea is a dermatologic condition that affects the midfacial region. Ocular rosacea is most frequently diagnosed when cutaneous signs and symptoms are also present. Ocular manifestations are essentially confined to the eyelids and ocular surface. Ocular involvement ranges from minor irritation, dryness, and blurry vision to potentially severe ocular surface disruption including corneal ulcers, vascularization and rarely perforation. We present a 49-year-old Saudi Arabian female with the diagnosis of rosacea who presented with a peripheral corneal performation. The perforation was successfully managed by surgical repair, oral doxycycline and topical steroid. The final best corrected visual acuity was 20/30 after treatment. Early referral to an ophthalmologist and careful long-term follow-up are recommended.
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Affiliation(s)
- Khalid Al Arfaj
- Department of Ophthalmology, College of Medicine, King Faisal University, Dammam, Saudi Arabia
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Sadowsky AE. Dermatologic Disorders and the Cornea. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
ABSTRACT Corneal ulcers can cause significant loss of vision from scarring and astigmatism, but rapid management can limit the destruction and improve outcomes. Infectious ulcers usually resolve with antimicrobial treatment. Noninfectious ulcers, however, present a diagnostic and therapeutic challenge. They can often be resolved by eliminating toxic medications and providing surface support with lubrication and collagenase inhibitors, but resistant ulcers may need more aggressive therapy with bandage contact lenses, tarsorrhaphy, or autologous serum. Ulcers impending perforation require urgent surgical management (e.g., tissue glue, conjunctival flaps, or keratoplasty). Topical steroids are useful when the ulceration is secondary to inflammatory mediators, but they are contraindicated in corneal melts with minimal inflammation, such as those associated with Sjogren syndrome. Systemic immunomodulation is required in addition to topical therapy in the presence of autoimmune disease. Understanding of the pathological processes that occur in different types of corneal ulcers is essential to formulation of a logical and effective treatment plan. Newer, more targeted treatment modalities may offer treatment options that have greater efficacy and fewer adverse effects.
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Affiliation(s)
- Sonal S Tuli
- Department of Ophthalmology and the Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL USA.
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Bhatt PR, Lim LT, Ramaesh K. Therapeutic deep lamellar keratoplasty for corneal perforations. Eye (Lond) 2006; 21:1168-73. [PMID: 16691245 DOI: 10.1038/sj.eye.6702428] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES/AIMS Corneal perforation can be potentially blinding unless the integrity of the globe is restored quickly. Although penetrating keratoplasty (PK) may achieve this, it carries a high risk of endothelial rejection in inflamed eyes. Deep lamellar keratoplasty (DLK) may be an alternative option to PK in such eyes owing to its potential for a lower incidence of rejection. We report the efficacy of DLK in patients with corneal perforations. PATIENTS AND METHODS Four patients underwent layer-by-layer DLK for noninfective corneal perforation, after measures such as the use of a bandage contact lens, tissue adhesive, and conjunctival pedicle flap had failed. The preoperative visual acuity was hand movements in one patient, 1/60 in two, and 6/60 in one. All four had iris incarcerated within the corneal perforations. SF6 gas (three patients) and air (one patient) were injected into the anterior chamber at the end of surgery. RESULTS The integrity of the globe was restored in all four patients with an improvement in visual acuity (6/60 in one and 6/36 or better in three). The mean follow-up time was 7 months. All four patients had clear corneas 3 months postoperatively, apart from the area of the original perforation. There was no recurrence of ulceration or perforation. CONCLUSION DLK is a safe and effective therapeutic measure in the management of patients with corneal perforations acting to preserve the integrity of the globe and restore vision.
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Affiliation(s)
- P R Bhatt
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
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Ilango B. Reply to T Sandinha et al. Re: Superior forniceal conjunctival advancement pedicles (SFCAP) in the management of acute and impending corneal perforations. Eye (Lond) 2006; 20:1468. [PMID: 16628236 DOI: 10.1038/sj.eye.6702354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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