Emergency Autologous Tectonic Management Of Corneal Perforations: Successes And Limitations Of Tenon's Capsule Patching

To evaluate the efficacy and limitations of autologous Tenon's capsule and conjunctival techniques in the emergency management of corneal perforations. This study highlights the surgical outcomes of these "salvage" procedures across various etiologies and identifies critical success factors, such as perioperative inflammatory control, when donor tissues are unavailable.

Ophthalmology Department, 20 Août 1953 Hospital, Ibn Rochd University Hospital Center, Casablanca, Morocco.

A case series of 5 eyes with acute corneal perforations (2 post-traumatic, 2 Rheumatoid Arthritis [RA], 1 dystrophic graft failure) was analyzed. Surgical techniques included localized Tenon's patches (4 eyes) and one double-layered bipedicled bridge flap (Tenon's capsule and conjunctiva). In one RA case, patching was performed prior to systemic inflammatory control. All procedures were emergency interventions due to lack of immediate access to amniotic membrane or keratoplasty.

On postoperative day 1, 4 of 5 eyes showed anterior chamber reformation and successful sealing. However, the RA case where the Tenon's patch was applied before systemic corticosteroid therapy resulted in early suture dehiscence due to ongoing stromal melting. In contrast, the second RA case, managed with a conjunctival flap after a corticosteroid bolus, and the traumatic and dystrophic cases remained stable. No cases of endophthalmitis were reported.

Autologous Tenon's patching is a highly effective tectonic tool for emergency corneal sealing. However, its success in immune-mediated melting, such as in RA, is strictly dependent on concomitant systemic anti-inflammatory therapy. Without controlling the underlying collagenolysis, mechanical patching alone risks suture failure. This series confirms Tenon's tissue as a vital emergency resource while emphasizing the necessity of a combined medical-surgical approach.