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Gabriel Schaab, Christine Clavell, Himani Goyal; Corneal Patch Grafts: A Review of the Indications, Techniques, And Success Rates. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6044.
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To review the indications for segmental corneal transplantation, the surgical techniques used for creation of donor and host corneal buttons and placement of the grafts, and surgical success rates. Also, a novel surgical technique is introduced.
Retrospective case review.
An extensive review of the literature from 1983-2011 revealed that corneal patch grafts have been used for a number of disease processes and have been performed using a variety of techniques. Patch grafts have been effective in the treatment of corneal perforation/thinning due to trauma, keratitis, ectasia, and melting. Full-thickness and lamellar keratoplasty have been shown to be effective surgical techniques and have been used with circular, crescentic and mushroom shaped grafts. While a trephine is the most commonly used instrument to fashion circular corneal buttons, it is often not emergently available in a size small enough for patch grafts. We utilized two sterile dermatologic punch biopsy blades (separate blade for donor and host corneas) that were easily accessible for our emergency cases. These biopsy punch blades are available in 2-8mm diameter and are commonly used for skin biopsies. Interestingly, it has recently been shown that fibrin glue may be an effective alternative to the standard sutured wound closure. We found that studies have varied success rates (postoperative ocular stability without graft failure, repeat melt, or re-perforation) that range from 74-100%.Here we present two cases of emergent corneal patch grafts using dermatologic blades. Case 1 (4mm diameter): inferior corneal melt secondary to exposure keratopathy. Case 2 (5mm diameter): corneal melt from infectious keratitis. Both small grafts were fashioned with dermatologic punch biopsy blades with surgical success at the six-month follow-up visit.
A thorough review of the published literature shows that corneal patch grafting is an adaptable technique that can be used with a variety of vision threatening diseases. The rates of success are high, while the rates of repeat operation are considerably lower. Here we illustrate, for the first time, two successful cases that demonstrate the use of punch biopsy blades for corneal dissection. It is our hope that this technique can be used by other surgeons and will inspire further investigation into novel surgical techniques in corneal patch grafting.
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