Original article
Multilayered Gore-Tex Patch for Temporary Coverage of Deep Noninfectious Corneal Defects: Surgical Procedure and Clinical Experience

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Purpose

To evaluate the multilayer Gore-Tex patch as temporary coverage of deep, noninfectious corneal defects.

Design

Retrospective, interventional case series.

Methods

Setting: University Medical Center Schleswig-Holstein, Kiel, Germany. Patient population: Thirty-nine eyes of 38 patients with noninfectious, deep corneal defects. Underlying disorders included neurotrophic or immunologic ulcers in 37 eyes (94.9%) and traumatic defects in 2 eyes (5.1%). Intervention procedures: Corneal defects were covered with multiple Gore-Tex layers, of which the uppermost was sutured to the cornea. The Gore-Tex patch was kept in place until an appropriate corneal transplant was obtained and effective systemic immunosuppression was initiated. Main outcome measures: Long-term preservation of the eye, frequency of resuturing of the Gore-Tex patch, and best-corrected visual acuity.

Results

In 38 cases, the eye could be preserved. In 10 eyes, additional sutures were required. Before surgery, the mean best-corrected visual acuity (logMAR) was 1.14 ± 0.45 (20/250), and that at final follow-up was 1.13 ± 0.41 (20/250). The Gore-Tex patch remained in place 4 days to 32 months (mean, 6.4 ± 8.3 months) until corneal transplantation (27 eyes) or until an alternative way of defect coverage could be performed. Three eyes did not require further coverage after explantation of the Gore-Tex patch. In 6 eyes, either the Gore-Tex patch was kept in place or the patients died.

Conclusions

Temporary coverage of deep corneal defects with multilayer Gore-Tex patches allows time until an appropriate corneal transplant is obtained. The technique is particularly useful in patients with underlying autoimmune disorders, because an effective systemic immunosuppression can be initiated before corneal transplantation.

Section snippets

Methods

The medical records of all patients treated with a temporary Gore-Tex patch between 2000 and 2008 were reviewed. The study was designed as retrospective interventional case series. Mean follow-up was 33.9 ± 29.2 months (range, 1.5 to 108 months). Thirty-eight consecutive patients (24 male, 14 female) with deep noninfectious corneal defects were included. One patient received a Gore-Tex patch in both eyes. Thirteen eyes had perforated corneal defect ulcers; in 11 eyes, a descemetocele was

Follow-up until Gore-Tex Patch Explantation

The Gore-Tex patches remained in place for a mean of 6.4 months (SD, 8.3 months; range, 4 days to 32 months). In 4 cases (10.3%), the patch has not been removed so far. Two patients died before the patch was removed. Indications for graft explantation were as follows: in 13 cases (33.3%), an HLA-matched keratoplasty was conducted (Figure 1, Bottom). Of these, 3 transplantations were without mismatches (MMs), 4 transplants had 1 MM, 4 transplants had 2 MMs, and 2 transplants had 3 MMs. In 14

Discussion

To our knowledge, the Gore-Tex patch as a therapeutic option to cover corneal defects has been reported only in several small case series.1, 10, 11 After the first report of Legeais and associates, who described watertight closure of the anterior chamber with a Gore-Tex patch,10 Huang and associates reported 3 cases of Gore-Tex patch coverage that were histologically evaluated.11 In the first case, a perforated corneal ulcer with progressive tissue melting could be stabilized for 2 months until

Florian Rüfer, MD, completed his medical degree at the Faculty of Medicine at Hannover Medical School, Germany. After residency at the University Hospitals of Hannover and Kiel, he has been working as permanent staff member in the Department of Ophthalmology at University Medical Center Schleswig-Holstein, Kiel, since 2007. His primary research interests are glaucoma and anterior segment surgery.

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    Florian Rüfer, MD, completed his medical degree at the Faculty of Medicine at Hannover Medical School, Germany. After residency at the University Hospitals of Hannover and Kiel, he has been working as permanent staff member in the Department of Ophthalmology at University Medical Center Schleswig-Holstein, Kiel, since 2007. His primary research interests are glaucoma and anterior segment surgery.

    Bernhard Nölle, MD, completed his medical degree at the Faculty of Medicine, Christian-Albrechts-University of Kiel, Germany. Doctoral thesis in 1992: Anti-Retina-Antibodies at the Institute of Immunology, Kiel. After residency in Internal Medicine 1986 to 1987, he completed ophthalmology in 1993. He is working as assistant medical director in the Department of Ophthalmology at University Medical Center Schleswig-Holstein, Kiel. Main clinical and scientific interests are ocular inflammation, systemic vasculitis, corneal transplantation, and anterior segment surgery.

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