Tectonic Patch Grafts: Corneal Surgeon

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Tectonic Patch Grafts Corneal Surgeons Friend
in Need

• Ayan Mohanta MS
• Arup Bhaumik MS
• Cataract , Cornea and Refractive services
• Disha Eye Hospitals
• Barrackpore, India

Authors have no financial Interest
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Purpose

• Tectonic Patch Grafts were performed in certain
  indicated sight threatening situations and study
  their outcome
• Simplify the intricacies involved in the
  positioning and fashioning of Patch Grafts

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Indications of Tectonic Patch Grafts

• Indications n
• Total 12
• Sterile perforations 4
• Perforations of infective origin
• Gonococcal keratitis 1
• Phaco tunnel infection 3
• Post PK Host bed infection 1
• Traumatic perforations 2
• Scleral melt 1

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Material and methods

• 2 types of grafts
• Full thickness preferred for infective
  etiologies
• Lamellar preferred for non infective situations
• Most patch grafts need to be fashioned freehand,
  here we have tried to use simple geometric
  principles to design the grafts with available
  trephines avoiding freehand excision as much as
  possible

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Scenario 1 Corneo-scleral patch grafts
Phaco tunnel infection
Step 2
8.5 mm trephination of a corneoscleral rim to
cut a similar size button at a same distance from
the limbus from the endothelial side
Step 1
8.5 mm trephine to encompass the lesion on the
cornea at a certain distance from the limbus
Step 3
Final trimming of the sclera to complete the
graft and suturing to the host bed
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Scenario 2 Predominantly peripheral corneal
banana grafts
Gonococcal infection
Corneal injury
Rheumatoid corneal melt
Extent of lesions(schematic)
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• After measuring the corneal diameter the widest
  point of the lesion was measured in each case(red
  arrow)
• A corneal rim was fashioned with the the help of
  2 trephines
• Trephine 1 selected by subtracting twice the
  diameter of the lesion from the corneal
  diameter
• Trephine 2 equal to the corneal diameter
• The corneal rim was then punched out from the
  sclerocorneal rim(Yellow)
• This yellow coloured rim was then cut and trimmed
  according to need.

Corneal rim
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Scenario 3 Predominantly Scleral/Corneal patches
not related to limbus
Scleral patch for ruptured cicatrix
Round circular patch for Corneal rupture with
tissue loss
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Results

• Anatomical restoration 11 eyes
• Evisceration 1 eye-270 corneal
  melt(below)
• Visual Restoration was good in small peripheral
  melts and scleral melts
• The acuity was dependent on the underlying
  severity of the disease process.

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Results
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Conclusion

• Tectonic graft is a useful therapeutic option in
  emergency sight threatening situations of
  corneal thinning and perforations as
• it effectively restores the integrity of the eye
  
• allows acceptable visual rehabilitation.

Thank You