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Outcomes of Fungal Corneal Ulcer with Impending Perforation after Temporary Suture Tarsorrhaphy
Sumit Singh Maharjan1, Aashish Raj Pant, Purushottam Joshi
1Patan Academy of Health Sciences, Lalitpur, Nepal.
Introduction:
This study aims to evaluate outcomes and complications of temporary suture tarsorrhaphy (TST) in cases of impending corneal ulcer perforation.
Materials And Methods:
Case records of patients who underwent temporary suture tarsorrhaphy at Mechi Eye Hospital during a period of 18 months were retrospectively evaluated. All the smear positive fungal keratitis with more than 5mm infiltration involving central and/or paracentral cornea with impending corneal perforation were included. Demographic and clinical profile including - visual acuity, indication for temporary suture tarsorrhaphy, duration of signs and symptoms were noted. The outcomes were evaluated after 1 month and 3 months post tarsorrhaphy, in relation with time to epithelial healing, anatomical success rate, best corrected visual acuity, complications associated with non-healing corneal ulcer, number of temporary suture tarsorrhaphy needed and complications of TST.
Results:
The study included 119 cases of smear positive fungal keratitis with mean age of 51.34 + 15.56 years. In this study, 56.30% of the patients developed epithelial healing at 2 - 4 weeks with mean duration of 23.24 + 12.09 days of temporary suture tarsorrhaphy. Out of 119 patients, the corneal ulcer healed in 84 patients (70.6%), whereas 35 (29.4%) did not heal. Among those with non-healing ulcers, 15 patients (12.6%) had to undergo evisceration. The anatomical success rate was 87.39% which was statistically significant (P = 0.001). Regarding visual outcome, in 62 patients (52.10%) BCVA improved by 2 or more lines, which was statistically significant (P<0.05) resulting in a functional success of 26.89%.
Conclusion:
This study concludes that temporary suture tarsorrhaphy could be a useful option for management of corneal ulcers with impending perforation in eye centers with limited resources settings and high disease burden with good anatomical and functional outcome.
Insights
Temporary suture tarsorrhaphy (TST) effectively manages impending corneal perforation, showing good anatomical and functional outcomes. This procedure is a viable option for resource-limited settings facing high fungal keratitis burdens.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Infectious Diseases
Background:
- Impending corneal ulcer perforation poses a significant threat to vision.
- Fungal keratitis is a prevalent cause of corneal ulcers, especially in resource-limited settings.
- Temporary suture tarsorrhaphy (TST) is a surgical technique to protect the cornea.
Purpose of the Study:
- To evaluate the outcomes and complications of TST in patients with impending corneal ulcer perforation.
- To assess the efficacy of TST in managing severe fungal keratitis.
- To determine the anatomical and functional success rates of TST.
Main Methods:
- Retrospective evaluation of case records of 119 patients undergoing TST at Mechi Eye Hospital.
- Inclusion criteria: smear-positive fungal keratitis with >5mm infiltration and impending perforation.
- Data collected: demographics, clinical profile, visual acuity, TST indications, duration of symptoms, and outcomes at 1 and 3 months post-procedure.
Main Results:
- Epithelial healing occurred in 56.30% of patients within 2-4 weeks.
- Corneal ulcer healed in 70.6% of patients; 29.4% did not heal, with 12.6% requiring evisceration.
- Anatomical success rate was 87.39% (P = 0.001), and functional success was 26.89% with BCVA improvement in 52.10% (P<0.05).
Conclusions:
- Temporary suture tarsorrhaphy (TST) is a valuable intervention for corneal ulcers with impending perforation.
- The procedure demonstrates good anatomical and functional outcomes, particularly in resource-limited settings.
- TST offers a viable management strategy for high-burden eye centers dealing with severe fungal keratitis.
