Combined Autologous Tenon Patch Graft and Conjunctival Advancement Pedicle Flap in the Management of Bilateral Large Corneal Perforations

Corneal perforations following an acute suppurative ulcerative keratitis are usually technically challenging to fix, particularly when the corneal defects are very large. We present an alternative surgical technique using a combined tenon patch graft (TPG) and a conjunctival flap. A 33-year-old male presented with 8 and 10 mm paracentral corneal defects in the right and left eyes, respectively, following a 3-week history of bilateral suppurative ulcerative keratitis. A tenon's tissue was harvested from each eye and sutured to cover the perforation, and a conjunctival pedicle flap was then created and advanced over the tenon graft. Parenteral and topical medications were administered postoperatively. Serial clinical follow-up was conducted to document healing. At first day postsurgery, the uncorrected visual acuity (UCVA) was 6/60 and the anterior chamber was formed. At discharge, conjunctivo-tenon graft/flap was intact, the eyeball was stable, and UCVA was 6/36 and 6/24 in the right eye and left eye, respectively. By 3 months postsurgery, the globe and conjunctivo-tenon graft/flap had further stabilized with UCVA of 6/18 and 6/12, respectively. At 6 months, the conjunctivo-tenon graft/flap was stable with UCVA of 6/18 and 6/12, respectively. With spectacle lenses correction, the vision was 6/9 (right eye) and 6/6 (left eye). Combined autologous TPG and conjunctival advancement pedicle flap is a viable alternative in restoring the structural and functional integrity of an eye following a peripherally located large corneal perforation.