Rajendra Prasad Centre for Ophthalmic Sciences, 28730All India Institute of Medical Sciences, New Delhi.
78595Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi.
Eur J Ophthalmol. 2022 Nov;32(6):3372-3382. doi: 10.1177/11206721221078682. Epub 2022 Mar 2.
To describe a novel modification of tuck-in Tenon's patch graft (TPG) using temporary horizontal mattress sutures and fibrin glue to hitch the graft in the management of corneal perforations.
Ambispective interventional case series.
Modified technique of autologous TPG was used to seal corneal perforations measuring 3-5 mm, using horizontal mattress sutures to hitch the graft in a lamellar pocket, followed by application of fibrin glue. The horizontal mattress sutures were removed after the reformation of the anterior chamber. The primary outcome measure was a well formed anterior chamber in the post-operative period and the secondary outcome was epithelization time.
The surgery was performed in 22 eyes. The mean age was 43.86 ± 16.02 (26-66) years, with 14 males and eight females. The etiologies of corneal perforation included dry eye (n = 10), neurotrophic keratitis (n = 6), trauma (n = 2), chemical injury (n = 2) and exposure (n = 2). The mean size of the perforation with the thinned-out area was 4.3 mm (range 3-5 mm). The mean duration of epithelialization was 14.31 ± 2.63 days (7-21 days). No intraoperative complications were observed. All eyes had a well-formed anterior chamber in the immediate postoperative period. Postoperatively, two eyes had graft pseudoectasia due to a thick graft and supra tenon haemorrhage each; one eye each had graft thinning with the formation of pseudopterygium and graft melting.
Tenon's patch graft, along with the use of temporary horizontal mattress sutures and fibrin glue, is an effective modification of the technique for managing corneal perforations measuring 3-5 mm.
描述一种使用临时水平褥式缝线和纤维蛋白胶将嵌顿式 Tenon 结膜瓣（TPG）固定于角膜穿孔的新型改良方法，以处理角膜穿孔。
前瞻性介入性病例系列研究。
采用改良自体 TPG 技术，用水平褥式缝线将移植物固定于板层袋内，以封闭直径 3-5mm 的角膜穿孔，随后应用纤维蛋白胶。在前房重建后，取出水平褥式缝线。主要观察指标是术后前房的良好形成，次要观察指标是上皮化时间。
共 22 只眼接受了手术。平均年龄为 43.86±16.02 岁（26-66 岁），其中男性 14 例，女性 8 例。角膜穿孔的病因包括干眼症（n=10）、神经营养性角膜病变（n=6）、外伤（n=2）、化学伤（n=2）和暴露（n=2）。穿孔伴变薄区的平均大小为 4.3mm（范围 3-5mm）。上皮化的平均时间为 14.31±2.63 天（7-21 天）。术中未观察到并发症。所有患者术后即刻均形成了良好的前房。术后，有 2 只眼因移植物厚且腱膜上出血而出现假性扩张，各有 1 只眼因移植物变薄伴假性翼状胬肉形成和移植物融化而出现移植物变薄。
Tenon 结膜瓣联合使用临时水平褥式缝线和纤维蛋白胶，是处理直径 3-5mm 角膜穿孔的有效改良方法。
