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Intralamellar autopatch with lamellar keratoplasty for paracentral corneal perforations
Jeewan S Titiyal1, Manotosh Ray, Namrata Sharma
1Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Purpose:
To report a new technique of tectonic intralamellar autopatch with lamellar keratoplasty (LK) for paracentral corneal perforations.
Methods:
A partial thickness lamellar dissection of the host was undertaken to remove the superficial epithelium and the anterior stroma. A second lamellar dissection began at the periphery to approximately 1 mm away from the perforation to fashion a hinge. The hinged autolamellar flap was reflected over the perforation and sutured to the host with interrupted sutures. Finally, the autolamellar patch graft was supported by a lamellar graft, which was secured in place with 16 interrupted sutures. This technique was undertaken in 4 eyes with paracentral perforation after trauma (2 eyes), after pterygium (1 eye), and inadvertent perforation during host bed dissection of large LK (1 eye).
Results:
All eyes achieved a stable ocular surface and a postoperative visual acuity of more than 6/60.
Conclusions:
Intralamellar autopatch with lamellar keratoplasty provides adequate tectonic support in cases of paracentral corneal perforation and thereby maintaining the integrity of the globe. It also provides ambulatory visual acuity.