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Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Tenon Patch Graft in Management of Impending or Full Thickness Corneal Perforation in Pediatric Patients
Hesham Mohamed El Mazar1, Mohamed Mostafa Al Makhlasawy2, Ahmed Ibrahim Basiony3
1Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia, 32511, Egypt.
Insights
Autologous Tenon's patch graft (TPG) successfully treated pediatric corneal perforations from infections. This procedure offers high healing rates and improved vision, serving as a valuable alternative when donor tissue is unavailable.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Infectious keratitis can lead to corneal perforations, especially in pediatric patients.
- Prompt surgical intervention is crucial to preserve vision and ocular integrity.
- Autologous Tenon's patch graft (TPG) is a potential treatment option for corneal defects.
Purpose of the Study:
- To evaluate the outcomes of autologous Tenon's patch graft (TPG) for impending or full-thickness corneal perforations in pediatric patients with infectious keratitis.
- To assess the efficacy and safety of TPG in this specific patient population.
Main Methods:
- A prospective interventional case series included 26 eyes of 26 children (≤16 years) with infectious keratitis and 3-5 mm corneal perforations.
- Autologous Tenon's tissue was harvested and sutured over the defect, followed by bandage contact lens and tailored antimicrobial therapy.
- Outcomes measured included visual acuity, Seidel testing, anterior chamber depth, epithelialization time, scar formation, and AS-OCT assessment over 3 months.
Main Results:
- Complete anatomical healing was achieved in 92.3% of eyes, with 96.2% maintaining a formed anterior chamber.
- Best corrected visual acuity (BCVA) improved significantly from a mean LogMAR of 1.75 to 1.32 (p=0.001).
- Anterior segment OCT showed complete stromal integration in 65.4% of eyes; only two eyes required penetrating keratoplasty.
Conclusions:
- Autologous TPG provides high anatomical success and significant visual improvement for medium-sized infectious corneal perforations in children.
- The procedure demonstrates minimal complications and is a valuable surgical option, particularly when donor tissue is scarce or emergency treatment is needed.
Purpose:
To evaluate the outcomes of autologous Tenon's patch graft (TPG) in impending or full thickness corneal perforations in pediatric patients with infectious keratitis.
Patients And Methods:
In this prospective, interventional case series, 26 eyes of 26 children (age ≤ 16 years) presenting with 3-5 mm impending or full thickness corneal perforations secondary to bacterial or fungal keratitis underwent autologous TPG. Tenon's tissue was harvested, fashioned to slightly exceed the defect diameter, and secured with interrupted 10-0 nylon sutures, followed by bandage contact lens placement. Postoperative topical antimicrobial therapy was tailored to the causative organism. Patients were examined preoperatively and followed up for 3 months. Outcome measures included best corrected visual acuity (BCVA), Seidel testing, anterior chamber depth evaluation, time of epithelialization and scar formation, and assessment by anterior segment optical coherence tomography (AS-OCT).
Results:
The cohort comprised 14 males and 12 females, mean age 9.4 ± 3.3 years. At three months, 24 eyes (92.3%) achieved complete anatomical healing, with 25 eyes (96.2%) maintaining a formed anterior chamber and testing Seidel negative. Mean LogMAR BCVA improved from 1.75 ± 0.59 to 1.32 ± 0.56 at 3 months (p = 0.001). AS-OCT demonstrated complete stromal integration without leucoma in 17 eyes (65.4%) and healed grafts with adherent leucoma in 7 eyes (26.9%). Two eyes (7.7%) required therapeutic penetrating keratoplasty for ongoing infection; one eye (3.8%) needed suture augmentation. No major intraoperative complications occurred.
Conclusion:
Autologous Tenon's patch graft for medium sized infectious corneal perforations in pediatric patients yields high anatomical success, significant visual improvement, and minimal complications. It represents a valuable option in settings where donor tissue is scarce or emergency intervention is required.
