Surgeons should individualize approaches for corneal perforations
LAS VEGAS — Christopher J. Rapuano, MD, discussed the “best candidates” for various types of corneal perforation treatments at the American Society of Cataract and Refractive Surgery meeting.
During Cornea Subspecialty Day, Rapuano highlighted several techniques for central and paracentral perforations. The best candidates for corneal glue are patients with concave ulcers, perforations that are less than 1 mm in size and patients who do not have perforations at the limbus, an area where glue “tends to fall off prematurely,” he said.
For smaller perforations, glue or multilayered amniotic membrane transplantation (AMT) is ideal. He said that a patch graft is useful for larger peripheral perforations while penetrating keratoplasty should be used in patients with large central perforations.
Rapuano also broke down techniques for each approach. For AMT, he recommended layering several pieces of AMT on top of one another without sutures, then covering them with a sutured piece to fill the divot. For glue, he suggested surgeons perform the technique in a minor surgery setting under an operating microscope, but it can also be done at the slit lamp. For patch grafts, he suggested preparing the donor tissue using the same size of punch around the perforation to create defined edges for the graft, performing a lamellar or full-thickness graft dissection, and then suturing the graft.
He said it is important to “individualize both intraoperative and postoperative care.”
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Rapuano CJ, et al. Central and paracentral corneal perforation. Presented at: American Society of Cataract and Refractive Surgery meeting; July 23-27, 2021; Las Vegas.
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