Tenon Patch Graft With Conjunctival Flap In Corneal Perforation

To elucidate the results achieved through the utilization of the Tenon Patch Graft with Conjunctival Flap for addressing corneal perforations.

52-year-old female patient presented with 2-mm limbal corneal perforation 12 weeks after penetrating trauma. A region of Tenon fascia was excised and sutured to close the perforation, followed by the creation and suturing of a conjunctival flap over the Tenon graft.  A bandage contact lens (BCL) was placed postoperatively. Sequential imaging, including optical coherence tomography (OCT) and slit lamp photography, was performed to monitor the healing process.

On examination, the patient had a visual acuity of 1/10 in the left eye, with a low digital tension. Slit-lamp examination showed paracentral full-thickness corneal perforation measuring 1.5×2 mm in size, Iris incarceration, and Seidel test was positive. The posterior segment was found to be normal. Anterior segment‑optical coherence tomography (AS‑OCT)  revealed a paralimbal corneal perforation measuring 2mm in diameter with thickening of the edges.

So, a Tenon's autologous patch graft was utilized as a scaffold and spread over the perforation. The procedure involved several steps: preparing the edges, assessing the defect size, creating a stromal pocket around the perforation margin, procuring the tenon graft, inserting it into the stromal pocket, and securing it by suturing with 10-0 monofilament nylon followed by the creation and suturing of a conjunctival flap over the Tenon graft. At the end of the procedure, anterior chamber (AC) was formed with air and BCL was placed.

At postoperative day 1, uncorrected distance visual acuity (UDVA) improved to 3/10, the anterior chamber was formed without iris incarceration, and AS‑OCT revealed Tenon fascia and conjunctiva covering the defect. At postoperative week 4, UDVA improved to 5/10, the leak resolved, and the Tenon graft was noted to be undergoing contraction, OCT revealed integration of the Tenon graft into the corneal stroma.

 Tenon Patch Graft emerges as a secure, straightforward, cost-efficient, and efficient approach for addressing corneal perforations. Its benefits lie in the autologous graft source, affordability, and ready accessibility.