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Naomi V. Odell, Tueng T. Shen; Repair of Acute Perforated Cornea with Modified Conjunctival Flap, Tissue Adhesive and Bandage Contact Lens. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6046.
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To review the outcomes of acute corneal perforation repair using a modified total or partial conjunctival flap with fibrin tissue adhesive and bandage contact lens.
Ten consecutive emergent referral cases of acute corneal perforation at the University of Washington were reviewed. All cases were repaired urgently during nights or weekends in a general trauma operating room setting. All open globes were repaired with dry amniotic membrane, fibrin glue and modified conjunctival flap with bandage contact lens. The causes of cornea perforation, immediate outcomes of globe repair, the follow-up frequency and the stability of the repaired globes were analyzed. Surgical success was defined as a stable ocular surface with no flap retraction or dehiscence, and no persistent symptoms or pain. Complications were noted as including progression of infectious or inflammatory process beneath the flap, flap loss from epithelial ingrowth, and epithelial cyst formation. Subsequent corneal surgeries to improve visual function were also reviewed.
The causes of acute corneal perforation include complications secondary to systemic conditions (such as Ectodermal dysplasia, Fabry’s Diseases, trigeminal nerve tumor, GVHD) and ophthalmic pathology (Terrien’s marginal degeneration, RK wound compromise, pterygium complications, and infection). All ocular surfaces of the ten eyes were stable at follow-up after surgery. All patients were able to return to the referring ophthalmologists locally for follow up care because most of the patients live more than 3 hours away from the UW center. All globes retained excellent integrity, normal IOP and acceptable appearance. Three patients with good visual potential underwent further corneal surgeries (Boston Keratoprosthesis, PKP) at 6 months without complications. Six of ten cases experienced subsequent visual acuity improvement either after initial surgery or due to subsequent corneal surgeries.
Modified conjunctival flap with dry amniotic membrane, fibrin tissue adhesive and BCL should be considered in an acute corneal perforation setting as a simple solution to restore globe integrity. This approach allows easy follow-up and preserves the eye for future corneal surgery under optimal conditions.
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