title: Large lamellar corneoscleral grafts: tectonic role in initial management of severe ocular chemical injuries.
abstract: OBJECTIVE
  To report the outcome of large tectonic lamellar grafts in cases of severe chemical injury associated with corneal melt/perforation and scleral ischemia, with or without retinal detachment.
  
  
  METHODS
  This was a retrospective interventional analysis of 7 eyes of 6 patients within 3 months of injury with simultaneous/subsequent surgical procedures to salvage globe integrity.
  
  
  RESULTS
  Of 7 included eyes, both eyes of one patient underwent phthisical changes. In one eye, the retinal detachment was inoperable; in another, the retina was reattached with silicone oil tamponade, and underwent subsequent Boston type 1 keratoprosthesis with a final best-corrected visual acuity of 20/80 at 3-year follow-up. One eye underwent Lucia type 2 keratoprosthesis, one eye the modified osteo-odonto keratoprosthesis procedure, with visual recovery of 20/120 and 20/80, respectively, and one maintained vision of 20/200 for 2 years following a penetrating keratoplasty. The final best-corrected visual acuity was better than 20/200 in 4 out of these 7 eyes (57.14%).
  
  
  CONCLUSIONS
  In acute severe chemical injuries, corneal perforation with scleral ischemia can threaten globe integrity as well as preclude routine tectonic penetrating procedure. Presence of a concurrent retinal detachment in this setting further complicates the approach as well as the outcome. The use of a large tectonic corneoscleral lamellar graft provides a viable option in the achievement of tectonic stability in these eyes, facilitating future visual rehabilitative procedures.
authors.affiliation: Medical & Vision Research Foundation, Chennai, Tamil Nadu - India.
authors.forename: Geetha
authors.initials: G
authors.lastname: Iyer
authors.affiliation: Medical & Vision Research Foundation, Chennai, Tamil Nadu - India.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Srinivasan
authors.affiliation: Medical & Vision Research Foundation, Chennai, Tamil Nadu - India.
authors.forename: Ekta
authors.initials: E
authors.lastname: Rishi
authors.affiliation: Medical & Vision Research Foundation, Chennai, Tamil Nadu - India.
authors.forename: Pukhraj
authors.initials: P
authors.lastname: Rishi
authors.affiliation: Medical & Vision Research Foundation, Chennai, Tamil Nadu - India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Medical & Vision Research Foundation, Chennai, Tamil Nadu - India.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Subramanian
mesh_terms: D000328:Adult; D002057:Burns, Chemical / Q000601:surgery*; D002387:Cataract Extraction; D003315:Cornea / Q000098:blood supply*; D057112:Corneal Perforation / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005126:Eye Burns / Q000139:chemically induced* / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D019654:Lens Implantation, Intraocular; D008297:Male; D012163:Retinal Detachment / Q000601:surgery; D012189:Retrospective Studies; D012590:Sclera / Q000637:transplantation*; D058475:Tenon Capsule / Q000601:surgery; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult