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    Strategies for surgical intervention aid in peripheral corneal disease

    C- or banana-shaped grafts can help maintain corneal integrity and contour



    Peripheral melting disorders require surgical intervention when all else has failed and there is an impending risk of perforation. A peripheral C- or banana-shaped graft can restore tectonic integrity while maintaining a reasonable corneal contour to preserve vision.



    By Lynda Charters; Reviewed by Donald Tan, FRCSE, FRCSG, FRCOphth

    Singapore—Surgical management of peripheral melting disorders may be required when all else has failed and an impending risk of perforation may exist.

    Primary problems associated with peripheral corneal diseases are disease progression in the form of progressive corneal thinning and corneal perforation, as well as secondary infection, irregular astigmatism, and ectasia.

    C- or banana-shaped grafts applied in the peripheral cornea can help maintain the corneal integrity and contour.

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    “The principle of surgical management of these complications is halting disease progression medically or systemically (by treating inflammatory or infection causes), and surgically restoring corneal integrity and anatomy by tectonic reconstruction of the peripheral cornea,” said Donald Tan, FRCSE, FRCSG, FRCOphth.

    Adjunctive procedures are gluing procedures, transplantation of amniotic membrane, and conjunctival resection.

    A minimalist approach is suggested in these cases, said Dr. Tan, the Arthur Lim Professor of Ophthalmology Endowed Chair, Duke-National University of Singapore Graduate Medical School, and professor of ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore.

    An anterior lamellar patch graft may be the best choice if the endothelium is not affected.

    “This will avoid involving the unaffected central cornea,” Dr. Tan said.

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