Management of Corneal Perforations: An Update

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2019 Dec 21

PMID 31856457

Citations 31

Authors

Rashmi Deshmukh

Louis J Stevenson

Rasik Vajpayee

Affiliations

Soon will be listed here.

Abstract

Corneal perforation is a potentially devastating complication that can result from numerous conditions that precipitate corneal melting. It is associated with significant morbidity and prompt intervention is necessary to prevent further complications. Causes include microbial keratitis, ocular surface disease, and autoimmune disorders and trauma. Various management options have been described in the literature to facilitate visual rehabilitation. This rview discusses the treatment options that range from temporising measures such as corneal gluing through to corneal transplantation, with decision making guided by the location, size, and underlying aetiology of the perforation.

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References

Boudreau N, Werb Z, Bissell M . Suppression of apoptosis by basement membrane requires three-dimensional tissue organization and withdrawal from the cell cycle. Proc Natl Acad Sci U S A. 1996; 93(8):3509-13. PMC: 39640. DOI: 10.1073/pnas.93.8.3509. View

Webster Jr R, Slansky H, Refojo M, BORUCHOFF S, Dohlman C . The use of adhesive for the closure of corneal perforations. Report of two cases. Arch Ophthalmol. 1968; 80(6):705-9. DOI: 10.1001/archopht.1968.00980050707004. View

GUNDERSEN T . Conjunctival flaps in the treatment of corneal disease with reference to a new technique of application. AMA Arch Ophthalmol. 1958; 60(5):880-8. DOI: 10.1001/archopht.1958.00940080900008. View

Sandinha T, Zaher S, Roberts F, Devlin H, Dhillon B, Ramaesh K . Superior forniceal conjunctival advancement pedicles (SFCAP) in the management of acute and impending corneal perforations. Eye (Lond). 2005; 20(1):84-9. DOI: 10.1038/sj.eye.6701814. View

Kiyoo N . [Interaction between corneal invasion of polymorphonuclear leukocytes and corneal epithelium]. Nippon Ganka Gakkai Zasshi. 1990; 94(5):445-56. View

Maccheron L, Daya S . Wedge resection and lamellar dissection for pellucid marginal degeneration. Cornea. 2012; 31(6):708-15. DOI: 10.1097/ICO.0b013e31824000e3. View

Cies W . The racquet conjunctival flap. Ophthalmic Surg. 1976; 7(4):31-2. View

Kilby M, Afford S, Li X, Strain A, Ahmed A, Whittle M . Localisation of hepatocyte growth factor and its receptor (c-met) protein and mRNA in human term placenta. Growth Factors. 1996; 13(1-2):133-9. DOI: 10.3109/08977199609034573. View

Mi S, Connon C . The formation of a tissue-engineered cornea using plastically compressed collagen scaffolds and limbal stem cells. Methods Mol Biol. 2013; 1014:143-55. DOI: 10.1007/978-1-62703-432-6_9. View

10.

Portnoy S, Insler M, Kaufman H . Surgical management of corneal ulceration and perforation. Surv Ophthalmol. 1989; 34(1):47-58. DOI: 10.1016/0039-6257(89)90129-x. View

11.

Refojo M, Dohlman C . The tensile strength of adhesive joints between eye tissues and alloplastic materials. Am J Ophthalmol. 1969; 68(2):248-55. DOI: 10.1016/0002-9394(69)94067-7. View

12.

Lin H, Ong S, Chao A . Eye preservation tectonic graft using glycerol-preserved donor cornea. Eye (Lond). 2012; 26(11):1446-50. PMC: 3496105. DOI: 10.1038/eye.2012.192. View

13.

Sharma A, Kaur R, Kumar S, Gupta P, Pandav S, Patnaik B . Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations. Ophthalmology. 2003; 110(2):291-8. DOI: 10.1016/S0161-6420(02)01558-0. View

14.

Lohchab M, Prakash G, Arora T, Maharana P, Jhanji V, Sharma N . Surgical management of peripheral corneal thinning disorders. Surv Ophthalmol. 2018; 64(1):67-78. DOI: 10.1016/j.survophthal.2018.06.002. View

15.

Golubovic S, PARUNOVIC A . Cyanoacrylate glue in the treatment of corneal ulcerations. Fortschr Ophthalmol. 1990; 87(4):378-81. View

16.

Korah S, Selvin S, Pradhan Z, Jacob P, Kuriakose T . Tenons Patch Graft in the Management of Large Corneal Perforations. Cornea. 2016; 35(5):696-9. DOI: 10.1097/ICO.0000000000000808. View

17.

Rana M, Savant V . A brief review of techniques used to seal corneal perforation using cyanoacrylate tissue adhesive. Cont Lens Anterior Eye. 2013; 36(4):156-8. DOI: 10.1016/j.clae.2013.03.006. View

18.

Dohlman C, Refojo M, Carrol J, Gasset A . Artificial corneal epithelium. Arch Ophthalmol. 1968; 79(3):360. DOI: 10.1001/archopht.1968.03850040362037. View

19.

Kurpakus M, Stock E, Jones J . The role of the basement membrane in differential expression of keratin proteins in epithelial cells. Dev Biol. 1992; 150(2):243-55. DOI: 10.1016/0012-1606(92)90239-d. View

20.

Lagoutte F, Gauthier L, Comte P . A fibrin sealant for perforated and preperforated corneal ulcers. Br J Ophthalmol. 1989; 73(9):757-61. PMC: 1041873. DOI: 10.1136/bjo.73.9.757. View