Selective Localized Tenonplasty for Corneal Burns Based on the Findings of Ocular Surface Fluorescein Angiography

Tabatabaei, Seyed Ali; Soleimani, Mohammad; Mirshahi, Reza; Zandian, Mehdi; Ghasemi, Hassan; Hashemian, Morteza; Ghomi, Zahra

doi:10.1097/ico.0000000000001256

Cited by 15 publications

(8 citation statements)

References 8 publications

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“…It can be a single early stage procedure, or combined with AMT. Anterior segment fluorescein angiography maybe considered to enable more selective localised tenonplasty [74]. It must be noted that Tenon advancement procedures are difficult in patients with acute injury due to the presence of friable and inflamed conjunctiva and Tenon's tissue.…”

Section: Sutureless Amniotic Membranementioning

confidence: 99%

An update on chemical eye burns

Bizrah

Yusuf²,

Ahmad

2019

Eye

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Ocular chemical injuries vary in severity, with the more severe end of the spectrum having profound visual consequences and medicolegal implications. Grading of ocular injuries is critical for determining acute treatment and visual prognosis. Poor immediate management results in more challenging treatment of acute disease. Similarly, poorly controlled acute disease results in more treatment-resistant chronic ocular disease. Despite several decades of research and public health initiatives, simple and effective interventions such as wearing protective eyewear and immediate irrigation of eyes remain as key challenges. Education and prevention are therefore important public health messages. Hurdles in the acute management of disease include poor evidence-base for commonly used treatments (e.g. based on experimental animal studies), reduced treatment adherence rates and high clinic non-attendance rates. The evolution of treatment strategies, particularly limbal stem cell transplantation, has revolutionised the visual and cosmetic outcomes in chronic phases of disease. It is therefore increasingly important to consider tertiary referral for patients with limbal stem cell failure or vision-limiting corneal scarring.

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Section: Sutureless Amniotic Membranementioning

confidence: 99%

An update on chemical eye burns

Bizrah

Yusuf²,

Ahmad

2019

Eye

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“… Selective tenonplasty is a procedure where limbal peritomy is performed in selected areas of limbal and scleral non-perfusion which are localized by FA. [ 28 ] Studies on this modification of tenonplasty have shown re-established perfusion, which was also confirmed on FA. [ 16 ] This procedure is less invasive when compared to a complete 360 degree limbal peritomy and may prevent the inadvertent removal of healthy limbal and conjunctival tissues.…”

Section: Surgical Techniquementioning

confidence: 75%

“…[ 16 ] This procedure is less invasive when compared to a complete 360 degree limbal peritomy and may prevent the inadvertent removal of healthy limbal and conjunctival tissues. [ 16 28 ] However, the procedure is dependent on FA or AS-OCTA confirmation of the ischemic area, and unavailability of these devices will limit the feasibility of the procedure. The combined use of an oral buccal mucous membrane with tenonplasty has been described in severe cases of scleral ischemia.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Table 1 gives an overview of all the studies where the outcomes of tenonplasty have been discussed in eyes with acute OCBs. All were non-comparative case series,[ 3 5 9 20 27 28 31 ] with the primary indication being conjunctival and scleral ischemia in severe cases of acute chemical injury (McCulley and Dua’s Grade IV and worse), except in the study by Peng W et al ,[ 5 ] where tenonplasty was performed in less severe grades of chemical injury (Dua’s grade 3 or better). These studies cumulatively included 222 eyes where a total tenonplasty was performed in 197 eyes (88.7%) and selective tenonplasty was performed in 25 eyes (11.3%).…”

Section: Surgical Outcomesmentioning

confidence: 99%

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The role of Tenonplasty in the management of limbal and scleral ischemia due to acute ocular chemical burns

Shanbhag¹,

Sharma²,

Kate

et al. 2022

Indian Journal of Ophthalmology

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Of the various manifestations of ocular chemical burns (OCBs), ischemia of the limbus and the peri-limbal sclera indicates poor prognosis and in severe cases threaten the integrity of the globe. Tenonplasty is a surgical procedure which involves advancing the Tenon’s capsule over the ischemic areas to provide a vascular supply and to enable migration of the conjunctival epithelium. This review aims to provide an overview of the diagnosis of limbal ischemia and its management with Tenonplasty. A literature review was conducted using the keywords “Tenonplasty,” “Tenon’s capsule,” “ocular chemical injury,” “ocular thermal injury,” “Tenon advancement,” “scleral ischemia,” and “limbal ischemia,” and outcomes were studied from seven selected articles. In addition to clinical evaluation, in vivo imaging techniques such as anterior segment optical coherence tomography angiography can provide an objective method of measuring and monitoring the ischemia and re-perfusion of the peri-limbal vasculature. Tenonplasty can be performed in eyes with acute OCBs with scleral or limbal ischemia by dissecting the Tenon’s layer from the orbit and securing it to the limbus. The indications, mechanism of action, peri-operative considerations, surgical technique, and post-operative care of Tenonplasty are discussed in detail. The average time for post-operative re-epithelization ranges from 1 to 6 months with the formation of a symblepharon being the most common complication. In conclusion, Tenonplasty is a globe-salvaging procedure in cases with severe limbal and scleral ischemia because of OCBs and has good anatomical outcomes priming the globe for subsequent re-constructive and vision-restoring surgeries.

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“…This procedure involves the advancement of Tenon's capsule to help re-perfuse the ischemic areas. The use of FA has been described to determine the area of limbal or scleral ischemia that will require the procedure, and the same purpose can be extrapolated to OCTA [49,50]. Furthermore, the extent of ischemia can be used to prognosticate the outcome in terms of vision and development of LSCD.…”

Section: Quantitative Assessment Of Limbal Vasculaturementioning

confidence: 99%

Role of Anterior Segment-Optical Coherence Tomography Angiography in Acute Ocular Burns

Kate

Basu

2022

Diagnostics

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Acute ocular burns have varied manifestations which require prompt diagnosis and management to prevent chronic sequelae. Of these, the detection of limbal ischemia poses a challenge because of the subjective nature of its clinical signs. Anterior segment optical coherence tomography angiography (AS-OCTA) offers an objective method of assessing ischemia in these eyes. This review provides an overview of the technology of AS-OCTA and its applications in acute burns. AS-OCTA generates images by isolating the movement of erythrocytes within blood vessels from sequentially obtained b-scans. Limbal ischemia manifests in these scans as absent vasculature and the extent of ischemia can be quantified using different vessel-related parameters. Of these, the density of vessels is most commonly used and correlates with the severity of the injury. Incorporation of the degree of ischemia in the classification of acute burns has been attempted in animal studies and its extension to human trials may provide an added dimension in determining the final prognosis of these eyes. Thus, AS-OCTA is a promising device that can objectively evaluate limbal ischemia. This will facilitate the identification of patients who will benefit from revascularization therapies and stem cell transplants in acute and chronic ocular burns, respectively.

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Selective Localized Tenonplasty for Corneal Burns Based on the Findings of Ocular Surface Fluorescein Angiography

Abstract: We observed acceptable outcomes in our patients after selective tenonplasty based on ocular surface angiography.

Cited by 15 publications

References 8 publications

An update on chemical eye burns

An update on chemical eye burns

The role of Tenonplasty in the management of limbal and scleral ischemia due to acute ocular chemical burns

Role of Anterior Segment-Optical Coherence Tomography Angiography in Acute Ocular Burns

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