ABSTRACT
Purpose: Comparison of the conjunctiva related complication rates and success rates among eyes with Ahmed glaucoma valve (AGV) implantation in which eye bank derived scleral and corneal patch grafts had been used to cover the tube. Methods: Retrospective comparative study. Patients who underwent AGV implantation between January 2000 to December 2016 were included. Demographic, clinical data, intra and post operative data was obtained from electronic medical records. Conjunctiva related complications were divided into two groups: with and without implant exposure. Conjunctiva related complication rates, success rate, risk factors among eyes with corneal and scleral patch graft were compared. Results: Three hundred and twenty three eyes of 316 patients underwent AGV implantation. Scleral patch graft was used in 214 eyes of 210 patients (65.9%) and corneal patch graft was used in 109 eyes of 107 patients (34%). Median follow up was 14 months. There was no significant difference in the conjunctiva related complication rate (7.3 % in corneal patch graft versus 7.0% in scleral patch graft;p=0.5) and conjunctival dehiscence rate (3.7% versus 4.6%, P = 0.7) among the two groups. Success rate was significantly higher in the corneal patch graft group versus the scleral patch graft group (98% versus 72%; p=0.001). Eyes with corneal patch graft had a higher survival rate (P = 0.01). Conclusion: There was no significant difference in the rate of conjunctiva related complications following corneal and scleral patch grafts used to cover the AGV tube. Eyes with corneal patch graft had a higher success rate and survival rate.
ABSTRACT
Objective@#To determine the efficacy of human corneal lenticule from small incision lenticule extraction (SMILE) with single blood donor fibrin glue as corneal patch for sealing induced corneal penetrating wounds in cadaveric porcine eyes compared to suturing using 2 simple interrupted nylon 10-0 sutures. @*Methodology@#This is an in vitro comparative experimental study using cadaveric porcine eyes. Twenty (20) porcine eyes were randomized into control and treatment groups. A 3-mm metal keratome was used to create a fullthickness incision with the keratome angled perpendicular to the central cornea. Seidel’s test was done to confirm leakage. An anterior chamber maintainer connected to the Centurion® Vision System (Alcon, USA) was inserted into a peripheral corneal incision with the infusion turned off. Induced corneal penetrating wounds were sealed by application of single blood donor fibrin glue and human corneal lenticule obtained from SMILE in the treatment group. In the control group, 2 simple interrupted nylon 10-0 sutures were used for wound closure. Intraocular pressure (IOP) was set at 30 mmHg using the Centurion® Vision System and IOP was increased by increments of 5 mmHg until leakage is documented. @*Results@#All porcine eyes in the control group showed no leakage immediately after sealing. One out of 10 eyes in the experimental group showed positive Seidel’s test after application of lenticule patch graft (odds ratio = 1.11 [0.904-1.336]). The mean leakage pressure for the suture group was significantly higher at 87.00 ± 4.83 mmHg compared to the lenticule group at 30.00 + 0.00 mmHg (p-value <0.001).@*Conclusion@#Human corneal lenticule from SMILE with single blood donor fibrin glue as cornel patch is less effective in sealing induced corneal penetrating wounds in cadaveric porcine eyes at IOP equal to or greater than 30 mmHg as compared to suturing using 2 simple interrupted nylon 10-0 sutures.
Subject(s)
Fibrin Tissue AdhesiveABSTRACT
PURPOSE: Corneal perforation from phlyctenular keratoconjunctivitis is rarely reported worldwide and no case has been reported in Korea. We report a case of corneal perforation in a patient with phlyctenular keratoconjunctivitis along with a literature review. CASE SUMMARY: A 15-year-old female presented to our clinic with repetitive tears, conjunctival injection, and discomfort in her right eye for several months. Slit-lamp examination revealed oily plugs at the meibomian gland orifices with collarettes, conjunctival injection and a round, whitish elevated lesion accompanying neovascularization of the inferotemporal side of the cornea. As an initial treatment, topical antibiotic was given but no signs of improvement were observed. Hence, topical steroid was applied on suspicion of phlyctenular keratitis and the patient's symptoms and corneal lesion improved. Two months later, the patient's symptoms relapsed and the lesion was found progressing towards the central cornea. The treatment was restarted and the symptoms improved but the corneal lesion continuously progressed towards the center, thinning the central cornea. Seventeen months from the time of initial diagnosis, the patient revisited prior to the scheduled appointment complaining of abrupt tears in her right eye. Slit-lamp examination revealed a corneal perforation at the center of the thinned cornea. Hence, we performed an emergent tectonic corneal patch graft. After the operation, opacity remained covering the visual axis at the central cornea, thus penetrating keratoplasty was performed 10 months later. Henceforth, the patient has remained free of symptoms and visual acuity has been recovered. CONCLUSIONS: Usually phlyctenular keratoconjunctivitis responds well to treatment and does not have a significant influence on vision. However, occasionally phlyctenular keratoconjunctivitis may not respond to treatment and may spread to the central cornea causing loss of visual acuity and even corneal perforation in rare occasions. Therefore, in order to prevent such complications, prompt diagnosis and treatment are essential.