Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Vision Eye Institute, Royal Victorian Eye and Ear Hospital North West Academic Centre, University of Melbourne, Melbourne, Australia.
Cornea. 2019 Aug;38(8):951-954. doi: 10.1097/ICO.0000000000001955.
To describe the outcomes of tuck-in tenon patch graft (TPG) in the management of corneal perforation up to 5-mm size.
Thirty-one cases of sterile corneal perforation (3-5 mm) underwent autologous TPG. The technique included, freshening of the edges, measuring the size of defect, creating a 360-degree stromal pocket around the perforation margin, harvesting the tenon graft followed by tucking into the stromal pocket, and application of cyanoacrylate glue or suturing the graft using 10-0 monofilament nylon suture. The main outcome measure was rate of healing (percentage of cases healed).
The mean age was 52.3 ± 8.9 years with 22 male and 9 female patients. The various etiologies of corneal perforation included trauma (n = 10), neurotrophic keratitis (n = 11), and peripheral ulcerative keratitis (n = 10). The mean size of corneal perforation was 4.2 ± 0.6 mm (range 3-5 mm). The mean duration of epithelial healing was 25.7 ± 6.7 days. Best-corrected visual acuity improved from 1.8 ± 0.4 to 1.2 ± 0.4 logarithm of the minimum angle of resolution units at 4 weeks after surgery (P ≤ 0.01). Twenty-seven (87.1%) cases healed with formation of a leucomatous scar at 16.9 ± 2.7 weeks, whereas 4 cases had a flat anterior chamber. In three-fourths of the cases, a corneal graft was performed. In one case, graft resuturing was performed for post-op aqueous leak, which healed with the formation of a corneo-iridic scar.
TPG is a safe, simple, inexpensive, and an effective technique for the management of corneal perforations. The advantages include the autologous nature of the graft, cost effectiveness, and easy availability.
描述 5mm 以内的角膜穿孔采用内卷式榫眼结膜瓣移植（TPG）治疗的结果。
31 例无菌性角膜穿孔（3-5mm）患者行自体 TPG。该技术包括：角膜缘清创，测量缺损大小，在穿孔边缘周围制作 360°基质口袋，采集榫眼移植物，将其内卷至基质口袋，应用氰基丙烯酸酯胶或用 10-0 单丝尼龙缝线缝合移植物。主要观察指标为愈合率（愈合病例百分比）。
平均年龄为 52.3±8.9 岁，男 22 例，女 9 例。角膜穿孔的各种病因包括创伤（n=10）、神经营养性角膜病变（n=11）和周边溃疡性角膜病变（n=10）。角膜穿孔的平均大小为 4.2±0.6mm（范围 3-5mm）。上皮愈合的平均时间为 25.7±6.7 天。术后 4 周最佳矫正视力从 1.8±0.4 提高至 1.2±0.4 对数最小分辨角单位（P≤0.01）。27 例（87.1%）患者在 16.9±2.7 周后形成白色瘢痕而愈合，4 例患者出现浅前房。四分之三的病例行角膜移植，其中 1 例因术后房水漏行移植片再缝合，愈合后形成角巩膜虹膜瘢痕。
TPG 是一种安全、简单、经济且有效的治疗角膜穿孔的方法。该方法的优点包括移植物的自体性质、成本效益和易于获得。
