Figure 1

1.Large perforated corneal ulcer

2.Total corneal abscess not responding to medical treatment.

Because of the avascularity of the cornea ,the natural forces do not come in to play early.It takes some days for the blood vessels to get the required initiative to invade the affected area and convert in to a desired opacity. Small perforations occuring as a result of corneal ulceration usually prove to be a blessing in disguise. Incarceration of iris helps to provide the required source of healing forces through the blood vessels which ultimately prove to be the winner. But if the perforation is big and in the centre, incarceration does not occur in the desired way. These are the cases suited for therapeutic grafting. It is an emergency. The involved area along with a rim of normal tissue is excised and donor tissue irrespective of whether it is fresh or glycerine stored is anchored with the help of sutures. My preferred sutures are steel sutures. The bites are superficial but the closure is strong. The deep needle tracks with nylon sutures tend to carry the infection in to the deeper layers of cornea where it becomes difficult to come in contact with the effect of the antibiotic drops resulting in reinfection. Luckily I have been able to save all the eyes using steel sutures. It is possible to restore some amount of vision with an optical graft done at the appropriate time.

Figure 2

Figure 3

Figure 4

Figure 5
All Images submitted by DR.KIRANJIT SINGH [email protected]

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