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Tectonic Patch Grafts: Corneal Surgeon’s Friend in Need

Tectonic Patch Grafts: Corneal Surgeon’s Friend in Need. Ayan Mohanta MS Arup Bhaumik MS Cataract , Cornea and Refractive services Disha Eye Hospitals Barrackpore , India. Authors have no financial Interest. Purpose.

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Tectonic Patch Grafts: Corneal Surgeon’s Friend in Need

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  1. Tectonic Patch Grafts: Corneal Surgeon’s Friend in Need Ayan Mohanta MS Arup Bhaumik MS Cataract , Cornea and Refractive services Disha Eye Hospitals Barrackpore, India Authors have no financial Interest

  2. Purpose • Tectonic Patch Grafts were performed in certain indicated sight threatening situations and study their outcome • Simplify the intricacies involved in the positioning and fashioning of Patch Grafts

  3. Indications of Tectonic Patch Grafts Indications n= Total: 12 • Sterile perforations: 4 • Perforations of infective origin Gonococcalkeratitis: 1 Phaco tunnel infection: 3 Post PK Host bed infection 1 • Traumatic perforations 2 • Scleral melt 1

  4. Indications Gonococcal keratitis with perforaton Phaco tunnel infection Rheumatoid corneal melting 270° Rheumatoid corneal melting Post Herpetic corneal scar with perforaton Corneal injury with tissue loss treated initially with glue Post PK host bed infection Ruptured Cystoid cicatrix

  5. Material and methods • 2 types of grafts: • Full thickness: preferred for infective etiologies • Lamellar: preferred for non infective situations • Most patch grafts need to be fashioned freehand, here we have tried to use simple geometric principles to design the grafts with available trephines avoiding freehand excision as much as possible

  6. Scenario 1: Corneo-scleral patch grafts Phaco tunnel infection Step 2 8.5 mm trephination of a corneoscleral rim to cut a similar size button at a same distance from the limbus from the endothelial side Step 1 8.5 mm trephine 8.5 mm trephine to encompass the lesion on the cornea at a certain distance from the limbus Step 3 Final trimming of the sclera to complete the graft and suturing to the host bed

  7. Scenario 2: Predominantly peripheral corneal banana grafts Gonococcal infection Corneal injury Rheumatoid corneal melt Extent of lesions(schematic)

  8. After measuring the corneal diameter the widest point of the lesion was measured in each case(red arrow) • A corneal rim was fashioned with the the help of 2 trephines • Trephine 1: selected by subtracting twice the diameter of the lesion from the corneal diameter • Trephine 2: equal to the corneal diameter • The corneal rim was then punched out from the sclerocorneal rim(Yellow) • This yellow coloured rim was then cut and trimmed according to need. Trephine 1 Trephine 2 Corneal rim

  9. Scenario 3: Predominantly Scleral/Corneal patches not related to limbus Scleral patch for ruptured cicatrix Round circular patch for Corneal rupture with tissue loss

  10. Results • Anatomical restoration: 11 eyes • Evisceration 1 eye-270° corneal melt(below) • Visual Restoration was good in small peripheral melts and scleral melts • The acuity was dependent on the underlying severity of the disease process.

  11. Results

  12. Conclusion • Tectonic graft is a useful therapeutic option in emergency sight threatening situations of corneal thinning and perforations as • it effectively restores the integrity of the eye • allows acceptable visual rehabilitation. Thank You

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