Tectonic Patch Grafts Corneal Surgeons 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 • 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

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

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

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

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 8. 5 mm trephine Step 1 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

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

Trephine 1 Trephine 2 §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 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. Corneal rim

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

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.

Results

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