Tenon's Patch Graft: A Review of Indications, Surgical Technique, Outcomes and Complications

Kate, Anahita; Vyas, Sonal; Bafna, Rahul Kumar; Sharma, Namrata; Basu, Sayan

doi:10.1080/08820538.2021.2017470

Cited by 10 publications

(12 citation statements)

References 21 publications

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“…Although Tenon patch grafting of corneal perforations has been described, 10 we believe the addition of a separate overlying conjunctival flap containing a vascular pedicle represents an advancement over previous techniques. A flap of Tenon advanced from the limbus has been shown to have a flattening effect on the cornea, 6 whereas a conjunctival pedicle introduces nutrients to facilitate rapid wound healing without inducing significant astigmatism.…”

Section: Discussionmentioning

confidence: 95%

Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation

Shekhawat

Kaur

Edalati

et al. 2022

Cornea

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Purpose: Traumatic paracentral corneal perforations may lead to irregular astigmatism and opacification from lamellar grafts. We present an alternative surgical technique using a Tenon patch graft and a conjunctival flap.Methods: A 42-year-old man presented with a 1-mm paracentral corneal perforation 6 weeks after penetrating trauma by a metallic foreign body. A region of Tenon fascia was excised and sutured to cover the perforation, and a conjunctival flap was then created and sutured over this Tenon graft. A bandage contact lens was placed postoperatively. Serial imaging was conducted to document healing including optical coherence tomography (OCT) and slit lamp photography.Results: At postoperative day 1, uncorrected distance visual acuity (UDVA) was hand motion, the anterior chamber was formed, and OCT revealed Tenon fascia and conjunctiva covering the defect. By postoperative week 2, the leak resolved and UDVA was 20/30. At postoperative week 4, UDVA improved to 20/20, the Tenon graft was noted to be undergoing contraction, and a single feeder vessel remained prominent in the conjunctival flap. By postoperative month 4, UDVA was 20/25 and only mild paracentral cornea clouding was noted. Initial, focal steepening and thickening normalized by month 4 leaving mild, normal astigmatism. OCT revealed integration of the Tenon graft into the corneal stroma.Conclusions: For paracentral corneal perforations, a Tenon patch graft in conjunction with a conjunctival flap may aid healing with favorable postoperative refractive outcomes.

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Section: Discussionmentioning

confidence: 95%

Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation

Shekhawat

Kaur

Edalati

et al. 2022

Cornea

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“…A total of 84 cases of its use have been documented from 2012 to 2022. [ 8 9 10 11 12 13 14 15 16 ] Most reports come from India, perhaps due in part to the shortage of donor tissue for keratoplasty in emergency settings. In fact, 79% of our procedures were performed between March 2020 and August 2021 when there was a shortage of donor tissue during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…The TPG was then placed over the perforation covering its edges or on the Descemet membrane, which was further secured by overlay sutures of infinity shape by using 10-0 monofilament nylon. [ 10 ] Additional interrupted sutures were applied whenever required. All the limbs of the overlay suture intersected each other over the defect [ Fig.…”

Section: Methodsmentioning

confidence: 99%

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Clinical outcome and course of Tenon’s patch graft in corneal perforation and descemetocele

Kusumesh

Ambastha

Singh

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To assess the efficacy and clinical outcome of Tenon’s patch graft (TPG) in corneal perforation and descemetocele. Methods: In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68%) or descemetocele (27, 32%) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS-OCT) were performed on every follow-up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). Results: The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow-up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48% and autoimmune disorders in 35% of cases. TPG successfully restored the globe integrity in 74 (87%) eyes (83% in perforation and 96% in descemetocele). Anatomical failure occurred in 11 eyes (13%). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. Conclusion: TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS-OCT is a valuable noninvasive tool for monitoring the graft status.

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“…The advantages of the tenon patch included the autologous nature of the graft, cost-effectiveness, and easy availability. 54 , 55 Chaudhary et al described the long-term successful outcome of Tenon’s patch graft in a case of corneal perforation secondary to Herpes Zoster Ophthalmicus. The authors performed subsequent cataract surgery with gratifying results.…”

Section: Limitationsmentioning

confidence: 99%

Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions

Sharma¹,

Sharma²,

Basu³

et al. 2023

OPTH

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Corneal perforations are ophthalmological emergencies which can have serious and detrimental consequences, if not managed timely and appropriately. These are a significant cause of ocular morbidity and can result in decreased vision, blindness, and even loss of the eye. Corneal perforations can be managed using a range of treatment approaches, including temporary solutions such as the application of corneal glue and bandage contact lens, as well as definitive treatment such as corneal transplantation. Tissue glues/adhesives were developed as substitutes for sutures in ophthalmic surgery. Unlike sutures, these glues are associated with shorter overall surgical times and reduced inflammation, thus improving postoperative comfort without compromising wound strength. The available tissue adhesives can be broadly classified into two types: synthetic (eg, cyanoacrylate derivatives) and biological (eg, fibrin glue). Cyanoacrylate glue is chiefly used as a corneal patch to manage acute corneal perforations and improve visual outcomes. Fibrin glue can be used instead of cyanoacrylate glue in many conditions with the benefits of reduced conjunctival and corneal inflammation and reaction. Apart from this, each type of adhesive is distinct in terms of its benefits as well as limitations and is accordingly used for different indications. The present review focuses on the two main types of tissue adhesives, their applications in the management of corneal perforations, the associated complications, safety and efficacy data related to their use available in the literature and the need for newer adhesives in this field.

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Tenon's Patch Graft: A Review of Indications, Surgical Technique, Outcomes and Complications

Cited by 10 publications

References 21 publications

Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation

Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation

Clinical outcome and course of Tenon’s patch graft in corneal perforation and descemetocele

Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions

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