Outcomes of Penetrating and Lamellar Corneal Patch Grafts

Abstract

Purpose: To report the indications, long-term structural and functional outcomes, and prognostic factors for the success of penetrating and lamellar corneal patch grafts.Methods: This is a retrospective analysis of 49 patients who underwent the corneal patch graft procedure over 8 years. The baseline, preoperative, and postoperative characteristics along with their outcomes were evaluated.Results: Forty-nine eyes (49 patients) with a mean follow-up of 20.3 6 3.27 months (range 6-48) were included. Thirty-one patients underwent full-thickness grafts for corneal perforation, and 18 underwent lamellar grafts for severe thinning. The most common indication was corneal thinning and/or perforation secondary to microbial keratitis (17 eyes, 34.7%). Anatomic success was achieved in 31 eyes (63.2%), in which no further surgical intervention was required for tectonicity. Functional success was achieved in 22 of 37 eyes (59.5%), where along with anatomic success, significant visual gain was also obtained. Absolute graft failure was noted in 12 eyes (24.5%), which developed recurrence of primary pathology requiring reintervention within the first 6 months. Good prognostic factor for success included sterile corneal perforations. The presence of microbial keratitis was noted to be a guarded prognostic factor for success.Conclusions: Corneal patch graft can serve as a good therapeutic modality for corneal ulceration or thinning, not amenable to treatment with tissue adhesive application. Both anatomical success and functional success of 60% was achieved in our series. Those performed for immune-mediated conditions fared the best. Subsequent optical procedures may be performed for further visual rehabilitation at a later stage.

Management of simultaneous bilateral immune-mediated peripheral ulcerative keratitis

“…Sharma et al 9 reported an anatomical and functional success rate of 60% by using lamellar and penetrating corneal patch grafts for treating corneal perforations arising from various etiologies. Similarly, we were also successful in maintaining tectonic stability and obtaining a final best corrected visual acuity of logMar 0.1 in OS by using the anterior stromal cap of a pre-cut DSAEK tissue for our corneal patch graft.…”

“…They used a multilayered AMT for managing impending perforation in the OS, which underwent rapid melting and subsequent reabsorption due to which a superficial anterior lamellar keratoplasty (SALK) had to be done. 8 Sharma et al 9 reported an anatomical and functional success rate of 60% by using lamellar and penetrating corneal patch grafts for treating corneal perforations arising from various etiologies. Similarly, we were also successful in maintaining tectonic stability and obtaining a final best corrected visual acuity of logMar 0.1 in OS by using the anterior stromal cap of a pre-cut DSAEK tissue for our corneal patch graft.…”

Therapeutic and Tectonic Keratoplasty with Simple Cryopreserved Remnants of Donor Corneas: An 11 Year Retrospective Case Series

“…Until recently, transplantation of fresh cornea tissue has been considered most appropriate in these cases if the donor cornea supply is su cient. Sharma S. et al reported that both functional and anatomical success were achieved for an average of 11 months in about 60% of patients with corneal ulceration, thinning, and perforation after corneal path graft 21 . However, cornea donor tissue is severely lacking in Asian countries [22][23][24] .…”

Management of corneal perforations in dry eye disease: Preferred practice pattern guidelines

“…In cases of corneal patch grafts (CPG), sources of donor tissue can include the anterior stromal cap obtained after preparing the lenticule for Descemet stripping automated endothelial keratoplasty and small incision lenticule extraction lenticules. [ 40 - 42 ] Grafts in these cases have epithelialization issues and thus they can be combined with an AMT to help improve the ocular surface. Additionally, a generous tarsorrhaphy is also advocated in these cases.…”