Tag: conjunctival flap

Herpes Zoster Ophthalmicus in Africa

In EnglishHerpes zoster ophthalmicus involves V1 cranial nerve (n.ophthalmicus). Here are three examples of herpes zoster in 2 young men and one 7yo girl. Both men are HIV-positive (this must be an AIDS-stage). HZO is definitely second quickest germ to penetrate and destroy the cornea. Pseudomonas has no chance in comparison to those two. HIV is certainly a boost for the fulminant clinic.

in Russian / по-русскиГерпес зостер c вовлечением первой ветви из моей африканской практики. Случай у двух взрослых мужчин и у девочки 7 лет (активный у мужчин, и в исходе у девочки). Herpes zoster ophthalmicus – наверное второй по скорости разъедания роговицы после гонококковой инфекции. Синегнойная палочка определённо нервно курит в сторонке. Мужчины были однозначно ВИЧ-положительны, а это, как известно, означает стадию СПИД. И это конечно одна из основных причин для такой яркой и драматической клинической картины.

Advanced herpes zoster ophthalmicus with corneal melt and lens/uvea prolapse. HIV positive patient.

Advanced herpes zoster ophthalmicus with corneal melt and lens/uvea prolapse. HIV positive patient.

Advanced herpes zoster ophthalmicus with resultant corneal leucoma in 7yo girl.

Advanced herpes zoster ophthalmicus with resultant corneal leucoma in 7yo girl.

Advanced herpes zoster ophthalmicus with corneal melt and iris prolapse. HIV positive patient.

Advanced herpes zoster ophthalmicus with corneal melt and iris prolapse. HIV positive patient. Failed conjunctival flap adherence depicted.

Conjunctivotenon’s total flap for hopeless corneal laceration

In EnglishThis is a good technique for cases, where the laceration of cornea is melting, and this does not seem possible to close the wound adequately with nylon sutures. This usually happens when patients delay visit to the hospital much.

This unfortunate boy got bad corneal trauma in April 2017, and during revision under anesthesia it stroke me that I am not able to close the wound and seal the anterior chamber properly. Immediate action was to do a total conjunctivotenon’s flap with intention to salvage the eye at least, though not the vision. I did a couple of Gundersen’s horisontal  total conjunctival flaps and find it a bit cumbersome. Technique, where you don’t care of button-holes, while you are dissecting tenon’s and not conjunctiva, suited the situation best. This is a classic Kuhnt’s style vertical total flap, but also including tenon’s, and not just conjunctiva.

It does not just make surgery faster, but also provides more opportunities to seal the anterior chamber in case of big melting hole. Tenonplasty accelerates wound healing and provides robust scarring, as recent paper states (PMID: 28612422). In future it allows anterior segment reconstruction with corneal grafts and possible cataract surgery.

Tarsorrhaphy for two weeks helps a lot to preserve the flap in place.

Tenonplasty

Total conjunctivotenon’s flap for corneal melted laceration. Intraoperative picture.

 

Total conjunctivotenon’s flap for melting corneal laceration. Postop status 3 months.