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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 corneal tissue is matched to the bed and sutured in place. A lamellar or full-thickness dissection can be performed using the same marking trephines used for the recipient bed.

    Some considerations

    One factor to consider is whether a patient has ectasia. Cases of classic Mooren’s syndrome, Dr. Tan pointed out, may not have ectasia. However, other peripheral noninflammatory disorders, such as pellucid marginal degeneration, have substantial thinning, protrusion, and bulging.

    “In the thin periphery, the same C-shaped lamellar graft can be applied,” he said. “However, ectasia can be prevented by using a smaller-sized donor tissue that is sutured tightly with interrupted 9/0 nylon sutures, which splints the cornea, and negates the ectasia.”

    In this situation, the compressive lamellar donor graft is narrower than the recipient bed.

    “We can effectively reduce a great deal of astigmatism and ectasia using this type of graft and tight suturing,” he said. “The intended overcorrection can subsequently be reversed with careful sequential suture removal several months later.”

    Dr. Tan highlighted the case of a 76-year-old woman with rheumatoid arthritis. In 2006, the left eye of the patient had a corneal melt adjacent to a pterygium, which was excised and a conjunctival graft put into place. In 2008, the corneal again melted and the rheumatoid arthritis was confirmed. The patient was treated for years with a systemic medication. A second lamellar patch procedure was performed, demonstrating the repeatability of the surgery.

    Three years later, another melt occurred away from the graft with tapering of the systemic medications. In 2011, another melt occurred and a fourth graft was applied. In 2014, an intrastromal crystalline opacity developed between the four grafts, which was suspected to be a fungal infection and progressed to another melt.

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