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New Surgical Modality for Management of Corneal Perforation Using Bowman Membrane
Dharamveer Singh Choudhary1, Nikhil Agrawal
1Upgraded Department of Ophthalmology, SMS Medical College, Jaipur, Rajasthan, India.
Purpose:
To describe a new surgical modality, "Bowman membrane tuck-in," for management of small to medium sized corneal perforation of a noninfectious etiology.
Methods:
Two patients with corneal perforation of a noninfectious etiology and less than 4 mm in size underwent Bowman membrane tuck-in, a new surgical procedure. In this technique, Bowman membrane harvested from the donor cornea was tucked inside the stromal pocket of host tissue, which was prepared by 360-degree anterior stromal lamellar dissection. Patients were followed up for 6 months and were examined for best-corrected visual acuity, epithelialization time, anterior chamber stability, and graft-related complications.
Results:
During 6-month follow-up, best-corrected visual acuity improved from PL+ (positive) to 20/120 and 20/200 in patient 1 and patient 2, respectively, and epithelialization was completed within a 2-week period in both patients. Surgery was uneventful in both cases; however, anterior chamber re-formation and graft repositioning were performed in patient 1. None of the patients showed signs of rejection or graft failure at 6-month follow-up.
Conclusions:
Bowman membrane tuck-in is an effective sutureless and glueless technique for management of corneal perforation of a noninfectious etiology, which may be used in emergency settings for the management of noninfectious corneal perforation of size less than 4 mm.
Insights
Bowman membrane tuck-in is a new sutureless technique for noninfectious corneal perforations. This method shows promise for emergency management of small corneal defects.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Regenerative Medicine
Background:
- Corneal perforation presents a significant challenge in ophthalmology.
- Noninfectious etiologies require specialized management strategies.
- Existing treatments may involve sutures or glues, posing potential complications.
Observation:
- A novel surgical technique, Bowman membrane tuck-in, was employed in two patients.
- The procedure involves tucking donor Bowman membrane into a host stromal pocket.
- This was performed for small to medium-sized (less than 4 mm) noninfectious corneal perforations.
Findings:
- Both patients achieved improved best-corrected visual acuity within 6 months.
- Epithelialization occurred within two weeks post-procedure.
- No signs of graft rejection or failure were observed at 6-month follow-up.
Implications:
- Bowman membrane tuck-in offers an effective sutureless and glueless approach.
- This technique may be suitable for emergency management of specific corneal perforations.
- Further research can explore its broader application in corneal reconstruction.
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