Abstract

SA.20.05

Gore-Tex®-Patches for temporary coverage of corneal defects

Johannes Eisenack, Florian Rüfer, Gundolf Westphal, Jost Hillenkamp, Johann Roider, Bernhard Nölle
Klinik für Ophthalmologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

Objective
Penetrating or lamellar keratoplasty, amniotic membrane transplantation, contact lenses or conjunctival flaps are used for surgical coverage of severe corneal ulcers. Allogenic organic tissues can be rejected promptly and may lead to stimulation of the afferent immunological pathway. In these cases non-immunogenic tissues have favourable effects and are additionally able to mechanically stabilize corneal surface defects. We report on the use of Gore-Tex®-patches for corneal ulcers.
Methods
38 consecutive patients underwent surgical Gore-Tex®-patch (polytetrafluorethen) coverage during January 2000 and December 2008. 11 cases (27%) suffered from perforated corneal ulcers. 14 cases (34%) showed a non-perforated corneal descemetocele. In 15 cases (37%) superficial corneal ulcers lead to the operation. 15 patients (37%) previously underwent corneal transplantation, 4 patients (10%) amniotic membrane transplantion. In 23 cases (56%) the Gore-Tex®-patch coverage was the primary intervention.
Results
The purpose of a long-term preservation of the globe could be achieved in 40 cases (98%). A primary water-tight wound closure was possible in 39 cases (95%). No peri- or postoperative infections occurred. Surgical revisions such as re-suturing or extended interventions were necessary in 12 cases (29%).
Conclusions
The surgical procedure of Gore-Tex®-patching for the treatment of corneal ulcers is usually doable. A disadvantage of the operation is the temporary nature. Difficulties arise from the lack of epithelial closure on the patch surface. During the operation, tissue samples can be taken. Usually the intervention can be performed under local anaesthesia. Thus time can be gained to internistically optimize the patients for further elective operations under general anaesthesia. Secondary procedures for visual improvement are usually necessary, as non-transparent tissue is implanted. Advantages of the method are based on the time saving possibility of effective systemic and topical immunosuppression. HLA-matched keratoplasty with the use of high-quality donor tissue can be carefully arranged.

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