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Impressum
Temporary cover of perforated corneal defects with a polyurethane patch
1Wach T., 1Noske W., 2Hoffmann F., 3Schmidt T., 3Maier M.
1Augenklinik Klinikum Brandenburg, Am Seegarten 2, 14774 Brandenburg; 2Augenklinik, Universitätsklinikum Benjamin Franklin, 12200 Berlin; 3Augenklinik rechts der Isar, TU München, Ismaningerstr.22, 81675 München
Objective: As the closure of perforated corneal defects with homologous
material may be problematic we have used microporous polyurethane patches
for temporary closure of such defects.
Methods/patients: The study compromises 21 covers of perforated
corneal defekts of 19 eyes (follow-up between 13 weeks and 5 years). The
corneal defect was covered with a non transparent microporous polyurethane
patch (Neuropatch, Braun, Melsungen, Germany), that was fixed with multiple
single sutures or by 2-3 transcorneal sutures that were anchored at the
limbal region. Additionally, in 10 cases the corneal defect was filled
under the patch with a button of sclera, in 10 cases firbin clue was used
and in 16 cases postoperatively an antifibrinolytic (aproptinin) was applied
topically.
Results: The flexible polyurethane material is extensible, easily
trimmed and can be fixed under some tension. Therefore, the operation
may be performed under local anesthesia. In all cases the leak was successfully
closed. The patch was removed 3 to 10 weeks after its placement, only
in one case a leak was seen in the region of the defect after removal
of the patch. The leak was successfully closed by a second patch. In two
patients a perforations occured 9 month and 11 months after patch removel,
both were closed successfully by repatching with polyurethane. In the
region of the stromal defect that had been filled with sclera epithelium
covered a thick stromal. Corneal vascularization depends on the duration
of patching, therefore, we recommend patch removal after 4 to 6 weeks.
Conclusions: The cover of perforated corneal defects with a polyurethane
patch may be used alternatively to other current methods. The material
is easily available, is not biodegradable and may easily be trimmed. In
order to avoid the problem of a thin cornea in the region of the stromal
defect the insertion of a scleral button is recommended.