ESCRS - CR23 - MANAGEMENT OF SEVERE OCULAR SURFACE ALTERATIONS WITH PILLAR TARSOCONJUNCTIVAL FLAP

MANAGEMENT OF SEVERE OCULAR SURFACE ALTERATIONS WITH PILLAR TARSOCONJUNCTIVAL FLAP

Published 2022 - 26th ESCRS Winter Meeting

Reference: CR23 | Type: Cornea Day Case Presentations | DOI: 10.82333/mpfq-wk78

Authors: Francisco Zamorano Martín 1 , Carlos Rocha de Lossada 2 , María García Lorente 1 , Facundo Urbinati* 3 , Marina Rodríguez Calvo de Mora 4 , Juan Carlos Sanchez-España 5 , Jorge Peraza-Nieves 6 , Santiago Ortiz-Perez 7 , Josep Torras-Sanvicens 6

1Ophthalmology,Hospital Regional Universitario de Málaga,Málaga,Spain, 2Cornea,Hospital Virgen de las Nieves,Granada,Spain, 3General,Hospital Regional Universitario de Málaga,Málaga,Spain, 4Cornea,Hospital Regional Universitario de Málaga,Málaga,Spain, 5Oculoplastics,Hospital Clínic,Barcelona,Spain, 6Cornea,Hospital Clínic,Barcelona,Spain, 7Oculoplastics,Hospital Virgen de las Nieves,Granada,Spain

To evaluate the effectiveness of the surgical procedure of the pillar tarsoconjunctival flap (PTCF) in severe ocular alterations of the ocular surface refractory to conventional treatments.

Retrospective cohort study of two patients who underwent a PTCF. The first one had neurotrophic keratitis and the second one, exposure keratopathy. Both cases had satisfactory results after surgery, showing total corneal re-epithelization that lasted the entire follow-up (mean 8 months). The mean time to re-epithelization was 5.5 days.

Case 1. A 44-year-old male with recurrent stromal herpetic keratitis. After resolution of the last episode, a paracentral persistent epithelial defect (PED) (4 x 2 mm) with an area of thinning remained. The patient referred great dysesthesia and photophobia and did not tolerate a bondage contact lens (BCL). After two months of unsuccessful treatment with artificial tears (AT), autologous serum (AS) and topical antibiotics, a PTCF was performed. After four days the symptoms had greatly improved, the epithelial defect healed and remained stable after six months of follow-up.

Case 2. An 80-year-old male after resection of a lower eyelid tumour covered with a skin flap developed an exposure keratopathy (EK) followed by a PED. Treatment with AT, AS and topic antibiotics proved to be unsuccessful because of the absence of the inferior part of the orbicular muscle. Despite three months of intensive topical treatment, further progression of the PED with stromal thinning was observed. A PTCF was performed to reduce the effect of increased exposure due to poor orbicularis function secondary to the resection. A wet-chamber patch was added at night due to incomplete interpalpebral fissure closure. One week after the surgery the epithelial defect closed and the thinning healed, remaining stable after 12 months. 

The PFTC is a valid alternative to tarsorrhaphy, counting as main advantages the preservation of vision, lower risk of infectious keratitis, the possibility of examining the eye during the healing process and allowing the phenomenon of blinking. Its indications would be: neurotrophic keratopathy, exposure keratopathy and corneal melting.