Hybrid technique of tuck-in Tenon's patch graft and tissue adhesives and bandage contact lens (TABCL) for large corneal perforation in microbial keratitis

Author(s): Deepali Singhal (corresponding author) [1]; Prafulla K Maharana [2] Corneal perforation can develop due to trauma, inflammatory, and infective causes. Early management leads to timely healing, amenable to optical [...]
We describe the hybrid technique of tuck-in Tenon's patch graft (TPG) and tissue adhesive bandaged contact lens (TABCL) for large corneal perforations (>5 mm) with intact surrounding stroma. Management of large corneal perforation is often challenging, and urgent availability of donor cornea might be difficult; Tenon patch alone does not provide tectonic support; hence, this hybrid technique can be used safely in large perforations. This involves freshening the perforation edges, creating a 360[sup.0] stromal pocket, harvesting a Tenon's graft 1 mm oversized, tucking into the pocket, and suturing. Then areas of leakage were noted, and only those areas were supplemented with minimal cyanoacrylate glue (CG) at the graft edges. This technique was used in two eyes, one with a large corneal perforation and intact surrounding stroma and the other with 4 mm corneal fistula post healed keratitis with a failed primary TPG alone, and led to epithelialization and a smooth corneal surface at 6 weeks. The advantages include autologous tissue, cost-effective, easily available, minimal post-operative inflammation, vascularization, and surface irregularity. Keywords: Corneal perforation, glue, microbial keratitis, Tenon patch graft