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A. Neri, C. Macaluso, P. Scaroni, R. Leaci, E. Spaggiari, G. Ferrari; Protected Lamellar Corneal Patching of an Unsutured Full-Thickness Graft for Paracentral Corneal Perforations. Invest. Ophthalmol. Vis. Sci. 2010;51(13):788.
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to describe a mini-invasive surgical technique to repair paracentral corneal perforations.
a full-thickness corneal donor button is used as a suture-less plug, covered by a patching large corneal lamellar graft sutured in the periphery of the recipient cornea. Both the plug and the lamella are obtained from the same donor cornea. The lamellar patch may be removed after adequate cicatrization has occurred, leaving the central cornea virtually untouched by the overall procedure.
We used this technique in one patient with traumatic corneal perforation, obtaining excellent functional recovery and minimal astigmatism induction. The cornea was clear just few days after primary surgery. One month later best-corrected visual acuity was 20/40 with the stabilizing donor lamella still in place. Two weeks after removal of the lamellar patch the corrected visual acuity was 20/25 with cyl-2@180°. Ten months after primary surgery, best-corrected visual acuity in the operated eye was 20/20 (sph+0.50 cyl-1.50@180°). The endothelial cell density was 2000 cells / mm2 in the operated eye and 2500 cells / mm2 in the fellow eye.
Corneal perforations are ophthalmological emergencies that may lead to severe complications. First-line conservative treatments, although successful in restoring eye integrity, often achieve suboptimal visual outcomes, usually requiring keratoplasty at a later stage. This technique may be useful in the treatment of selected cases of corneal perforation, as it may restore eye integrity and visual function with a single procedure.
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