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    Expert tips for surgically managing corneal perforations

     

    General ophthalmologists may be able to treat peripheral perforations less than 2-3 mm in diameter on their own. Gluing may work as a definitive procedure for these holes, Dr. Tuli said. She recommends cyanoacrylate glue. “You essentially want to plug the hole to allow the tissues to heal underneath,” she said.

    Another option, especially useful in neurotrophic ulcers, is a pedicle conjunctival flap, which may allow fibrovascular tissue to cover the area, providing serum and growth factors.

    Pleated or multilayer-amniotic membranes can be sutured or glued over the perforation as a third option.

    For central perforations of this size, on the other hand, Dr. Tuli uses glue or amniotic tissue as a temporizing measure. “A small perforation in the center of the cornea won’t heal very well,” she said. “There are no blood vessels to provide fibrovascular scar tissue.” For these holes, corneal transplants are generally the definitive treatment, she said, and general ophthalmologists will usually want to refer these cases to specialists.

    Likewise, perforations larger than 3 mm generally also require emergent corneal transplantation, and are best treated by an expert, Dr. Tuli said.

     

     

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