Literature DB >> 33727490

Response to comments on: Intracorneal scleral patch supported cyanoacrylate application for corneal perforations secondary to rheumatoid arthritis.

Ashok Sharma1, Rajan Sharma1, Verinder S Nirankari2.   

Abstract

Entities:  

Year:  2021        PMID: 33727490      PMCID: PMC8012944          DOI: 10.4103/ijo.IJO_299_21

Source DB:  PubMed          Journal:  Indian J Ophthalmol        ISSN: 0301-4738            Impact factor:   1.848


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Dear Editor, Authors thank Dr Srirampur et al.[1] for their interest in our article entitled “Intracorneal scleral patch supported cyanoacrylate application for corneal perforations secondary to rheumatoid arthritis”.[2] We placed partial thickness scleral patch graft in the lamellar corneal pocket and applied cyanoacrylate tissue adhesive to seal corneal perforation in rheumatoid arthritis patients. We did not perform anterior segment optical coherence tomography of the cornea to confirm epithelialisation in our study. Fluorescein staining was used to detect epithelial defect and monitor healing. Dr et al.[1] have raised an important issue of risk of scleral necrosis on the basis of impaired nutrition of sclera patch. Before taking up that issue we will discuss why we preferred lamellar scleral patch. We had tried partial thickness cornea patch as scaffold initially to support cyanoacrylate tissue adhesive to treat corneal perforations larger than 3.0 mm diameter. But due to corneal hydration, stroma swelled and lifted up the cyanoacrylate adhesive plug. Because of this reason we used partial thickness sclera patch as scaffold to apply cyanoacrylate to treat moderate-sized corneal perforations successfully.[3] In addition, sclera is well-tolerated, induces very little inflammation, and suffers rare rejections.[4] Sclera is relatively avascular structure and has extremely low metabolic need. Sclera is covered internally by choroid and externally by episclera, Tenon‘s capsule and conjunctiva. Sclera does not tolerate exposure and dehydration. In our study, we placed the partial thickness sclera patch in the corneal pocket covered on one side by aqueous and cyanoacrylate tissue adhesive covered by bandage contact lens anteriorly. We did not observe scleral necrosis or ulceration in any of our patients. Probably, the nutrition to the scleral patch from aqueous and tear film was adequate. Scleral patch used as a scaffold has low cellularity in the form of fibroblasts. But over a period of time, collagenous fibers from the recipient cornea populate the sclera patch graft and replace scleral tissue.[5] Scleral patch grafts have shown significant clearing with time indicating that its fibers assume characteristics present in the cornea.[6] These factors coupled with corneal vacularization provided nutrition to the sclera patch and avoided scleral necrosis and ulceration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
  6 in total

1.  Use of an autologous lamellar scleral graft to repair a corneal perforation.

Authors:  J I Prydal
Journal:  Br J Ophthalmol       Date:  2006-07       Impact factor: 4.638

2.  The fate of scleral grafts in the cornea.

Authors:  D M Maurice; T Singh
Journal:  Cornea       Date:  1996-03       Impact factor: 2.651

3.  Structural and functional outcome of scleral patch graft.

Authors:  V S Sangwan; V Jain; P Gupta
Journal:  Eye (Lond)       Date:  2006-04-07       Impact factor: 3.775

4.  Scleral Patch Graft Augmented Cyanoacrylate Tissue Adhesive for Treatment of Moderate-Sized Noninfectious Corneal Perforations (3.5-4.5 mm).

Authors:  Ashok Sharma; Kanwar Mohan; Rajan Sharma; Verinder S Nirankari
Journal:  Cornea       Date:  2013-10       Impact factor: 2.651

5.  Intracorneal scleral patch supported cyanoacrylate application for corneal perforations secondary to rheumatoid arthritis.

Authors:  Ashok Sharma; Rajan Sharma; Verinder S Nirankari
Journal:  Indian J Ophthalmol       Date:  2021-01       Impact factor: 1.848

6.  Comments on: Intracorneal scleral patch supported cyanoacrylate application for corneal perforations secondary to rheumatoid arthritis.

Authors:  Arjun Srirampur
Journal:  Indian J Ophthalmol       Date:  2021-04       Impact factor: 1.848

  6 in total

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