Stenciling-Based “Prick and Print” Technique for Harvesting Shaped Corneal Grafts for Management of Peripheral Corneal Perforations

Abstract

Purpose: To evaluate a new surgical technique (“prick and print”) for harvesting shaped donor corneal grafts in cases with perforated peripheral ulcerative keratitis (PUK). Methods: We conducted a retrospective case series at a tertiary center. Medical records of 13 patients with perforated PUK, who underwent tectonic eccentric keratoplasty using the stenciling-based prick and print technique during the past 1 year, were reviewed. All patients (15 eyes of 13 patients) received grafts of varying sizes and shapes (14 crescentic and 1 biconvex). Factors evaluated were tectonic integrity, graft apposition, and complications, if any. Surgical success was defined as maintenance of corneal integrity and healing of PUK. Results: Mean age of patients was 40.6 ± 19.4 years. Mean follow-up was 10 months. We achieved surgical success in 80% (12/15 eyes) of cases. Two eyes had graft infection, and regrafting (large circular graft) was performed for both. One eye developed new-site PUK, which was managed medically, and the graft remained viable tectonically. After surgery, 9 eyes achieved a best-corrected visual acuity of logarithm of the minimum angle of resolution +0.3 or better. No cases had graft rejection or peripheral anterior synechiae by final follow-up. Conclusions: The stenciling-based prick and print technique for making shaped donor corneal grafts may offer a simple, easy-to-learn surgical technique that can be used to make any shape or pattern of donor corneal grafts without involving the optical center, even in extensive peripheral corneal lesions.

Novel technique of tetra trephination for elliptical-shaped tectonic patch grafts in peripheral sterile keratolysis

“…Parmar et al 10 Prick and Print: Stenciling Full thickness peripheral perforations 1. Host defect marked with a pen 1.…”

“…These include match and patch technique, mushroom shaped grafting, and free hand dissection for non-circular grafts. [8][9][10] However, all these techniques are complex and time-consuming. We describe a novel tetra-trephine technique of customized full thickness tectonic patch grafts for elliptical-shaped peripheral sterile keratolysis with perforations.…”

Peripheral ulcerative keratitis: A review of aetiology and management

“…26,125 Various techniques have been described to assist the surgeon in fashioning these crescentic grafts. 136,137,138,139…”

Bandage contact lens stencil for shaped corneal transplantation surgery in a case of peripheral corneal perforation

“…4 The prick and print technique involves the use of a transparent sheet to create a stencil, but is unsuitable for elevated or deeply excavated lesions as the sheet does not conform to the contours of the cornea. 5 In addition, the internal technique of sutureless pull through mini-DSAEK has also recently been described. 6 A material that conforms with the corneal curvature would provide a better stencil, thereby reducing the postoperative astigmatism in addition to being a 'no-touch' technique.…”

“…Among the free-hand techniques, the copy and fix method requires placement of the donor rim directly on the host defect, thereby increasing the possibility of endothelial cell loss and infection 4. The prick and print technique involves the use of a transparent sheet to create a stencil, but is unsuitable for elevated or deeply excavated lesions as the sheet does not conform to the contours of the cornea 5. In addition, the internal technique of sutureless pull through mini-DSAEK has also recently been described 6…”