|Year : 1983 | Volume
| Issue : 5 | Page : 669-670
Patch graft for corneal perforations
M. & J. Institute of Ophthalmology, Civil Hospital Ahmedabad, India
M. & J. Institute of Ophthalmology, Civil Hospital Ahmedabad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lavingia B. Patch graft for corneal perforations. Indian J Ophthalmol 1983;31:669-70
First objective in the treatment of corneal perforation is to restore or retain anterior chamber without damaging the lens and iris with maintenence of best possible visual acuity.
Corneal perforations can be treated in the following ways  :
Medical treatment-occlusion with pad -soft contact lens -tissue adhesives
Surgical treatment-conjunctival hooding -patch graft -keratoplasty
Small sharp sterile perforations can be sealed with cynoacrylate glue  , but it is highly irritant. It can only be used to form A.C. prior to keratoplasty.
Soft contact lenses can manage very small perforations  . Tissue glue, soft lenses or conjunctical hooding gives temporary cure. The underlying condition persists or heals temporarily, producing an intermitant leak, and interferes with vision if in the pupillary area. In these cases patch grafts give permanent cure. More central perforations are sealed with round trephine cut grafts, while peripheral perforations need a free hand suitable to the size and shape of the graft due to lack of space,,  .
| Materials and Methods|| |
16 patients of corneal perforations larger than 1 to 2 mm not manageable by soft contact lens or conjunctival hooding were treated by patch grafts.
Patients were selected from cornea clinic of M & J Institute of ophthalmology, Civil Hospital, Ahmedabad. Prior to surgery all the patients were treated with antibiotic locally till sterile culture was available. Three groups of cases were treated in different ways.
To group 1:-Central fistula with superficial infiltration in the stroma were treated mushroom graft central penetrating with a rim of lamellar graft. Bigget central perforations were treated with 5 mm central penetrating graft.
To group II-Peracentral perforations with iris prolapse were sealed with a lamellar graft sparing the pupillary area.
To group II Peripheral perforations with iris prolapse were sealed with freehand patch graft on the site of perforation.
In group II and III usually the perforation is sealed by iris prolapse, may be bare iris or covered with fibrinous material. A very simple procedure. An edge is needed for suturing of the patch graft. Small paracentesis is done away from the iris prolapse to allow leakage of little amount of aqueous. This causes flattening of iris prolapse. Adhesions with the margin of perforation, if present, were seperated with iris repositor and iris was reposited in A.C. as far possible. Host tissue was cut little out side the perforation in relatively uninvolved tissue, and removed with scissors or razor blade.
Central mushroom or penetrating grafts were done from fresh donor material; while paracentral and peripheral grafts can be done from preserved cornea. Glycerine preserved or preserved at-79° C also works. Peripheral penetrating grafts done from fresh donor may remain clear or some times completely opacity.
Bed was prepared for the graft and about 8 to 10 sutures were applied to fix the graft. 10 x 0 nylon or 8 x 0 virgin silk interrupted sutures were put. Air was injected through the paracentesis opening.
| Observations|| |
Group I All cases of mushroom graft remained clear in centre, that is in P.K. area, with good vision.
Lameller zone developed interface crystalline deposits after 4 to 6 months, which could be stopped to increase with corticosteroids, but the deposits already occured did not have any effect of the drugs.
Group II Lamellar graft took well except a small opacity at the site of attached iris tague.
Group III Peripheral perforations treated with free hand graft neatly healed. In all cases the graft became opaque, but the disease did not reccur in the graft with the follow up of 6 months.
| Summary|| |
Corneal perforation heal slowly. Firm scar is frequently delayed, giving rise to an intermittant fistula. Such patients if treated by patch graft at the side of perforation achieved permanent cure from the disease is achieved and visual function of the eye can be preserved.
| References|| |
Jones, D.B., Trans. of'New Orl. Acd. of Ophthal., 80,
Neusburn, A.B., Trans. of New Orl. Acd. Of Ophth., 80,
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Kaufman, H.E., Trans. of New Orl. Acd. Of Ophth., 80, 585.