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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


    “The crescentric-shaped graft also respects the central corneal shape,” he said. “The sutures can be tightened and with subsequent suture removal the astigmatism can be reduced. In addition, the procedure may be repeatable.”

    Dr. Tan reported the outcomes in 34 cases of Mooren’s ulceration in 22 patients treated with “banana” grafts who were followed for about 5 years.

    “About 50% of these patients required a second graft because of disease recurrence,” he said. “Tectonic success was about 88%.”

    Surgical procedure

    The procedure to create the recipient bed is not highly difficult, but requires careful attention to detail to reconstruct corneal anatomy, Dr. Tan noted. He described the technique in a patient with a banana-shaped corneal melt. Marking trephines are used to regularize the slightly irregular area of corneal melting. A central trephine is used to mark the central radius. A 13- or 14-mm trephine is used to mark the peripheral radius.

    Smaller-diameter dermatological trephines are useful to mark the edges of the banana shape, he noted.

    Dr. Tan cautioned against causing a perforation. Free-hand lamellar dissection is performed using a crescent blade.

    The donor procedure is performed using a 14-mm orbital glass implant that is covered with cloth. The implant is placed in a punch and sutured, which facilitates any desired tissue shape, he explained.

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