The Cornea Institute, KAR Campus, Hyderabad, Telangana, India.
The Cornea Institute, KVC Campus, LV Prasad Eye Institute, Vijayawada, Andhra Pradesh, India.
Indian J Ophthalmol. 2022 Sep;70(9):3203-3212. doi: 10.4103/ijo.IJO_3148_21.
Of the various manifestations of ocular chemical burns (OCBs), ischemia of the limbus and the peri-limbal sclera indicates poor prognosis and in severe cases threaten the integrity of the globe. Tenonplasty is a surgical procedure which involves advancing the Tenon's capsule over the ischemic areas to provide a vascular supply and to enable migration of the conjunctival epithelium. This review aims to provide an overview of the diagnosis of limbal ischemia and its management with Tenonplasty. A literature review was conducted using the keywords "Tenonplasty," "Tenon's capsule," "ocular chemical injury," "ocular thermal injury," "Tenon advancement," "scleral ischemia," and "limbal ischemia," and outcomes were studied from seven selected articles. In addition to clinical evaluation, in vivo imaging techniques such as anterior segment optical coherence tomography angiography can provide an objective method of measuring and monitoring the ischemia and re-perfusion of the peri-limbal vasculature. Tenonplasty can be performed in eyes with acute OCBs with scleral or limbal ischemia by dissecting the Tenon's layer from the orbit and securing it to the limbus. The indications, mechanism of action, peri-operative considerations, surgical technique, and post-operative care of Tenonplasty are discussed in detail. The average time for post-operative re-epithelization ranges from 1 to 6 months with the formation of a symblepharon being the most common complication. In conclusion, Tenonplasty is a globe-salvaging procedure in cases with severe limbal and scleral ischemia because of OCBs and has good anatomical outcomes priming the globe for subsequent re-constructive and vision-restoring surgeries.
在眼部化学烧伤（OCB）的各种表现中，角膜缘和球周巩膜缺血表明预后不良，在严重情况下会威胁眼球的完整性。Tenon 成形术是一种手术，通过将 Tenon 囊推进到缺血区域，提供血管供应，并使结膜上皮迁移，从而改善缺血状况。本综述旨在概述角膜缘缺血的诊断及其与 Tenon 成形术的治疗。通过使用关键词“Tenon 成形术”、“Tenon 囊”、“眼部化学损伤”、“眼部热损伤”、“Tenon 推进”、“巩膜缺血”和“角膜缘缺血”进行文献回顾，并从七篇选定的文章中研究了结果。除了临床评估外，活体成像技术如眼前节光学相干断层扫描血管造影术可以提供一种客观的方法来测量和监测球周血管的缺血和再灌注。急性 OCB 伴巩膜或角膜缘缺血的患者可通过从眼眶分离 Tenon 层并将其固定到角膜缘来进行 Tenon 成形术。本文详细讨论了 Tenon 成形术的适应证、作用机制、围手术期注意事项、手术技术和术后护理。术后再上皮化的平均时间为 1 至 6 个月，形成睑球粘连是最常见的并发症。总之，Tenon 成形术是一种挽救眼球的手术，适用于 OCB 引起的严重角膜缘和巩膜缺血的患者，具有良好的解剖学效果，为随后的重建和视力恢复手术做好准备。
