[Tenonplasty as a new surgical principle in the early treatment of the most severe chemical eye burns]

Abstract

A special danger in cases of severe chemical and thermal eye burns is the development of corneoscleral ulceration. To treat these most severe burns tenonplasty was developed as a new surgical treatment. The principle of tenonplasty is based on a plastic operation in which vital connective tissue of the orbit is used. First, all necrotic tissue is removed from the conjunctiva and sclera. The Tenon tissue is then bluntly separated from the equatorial region of the globe and from extraocular muscles. It is important to keep its blood vessels intact and to prepare the Tenon sheet with a smooth surface, because regenerating conjunctival epithelium has to slide on this layer. After preparation, the elastic Tenon flap can be moved to the limbus and sutured tightly to the sclera, thus providing a revascularization of the denuded sclera and the limbus region. In all patients the scleral ulceration healed and the eyes were saved from anterior segment necrosis. Although rapid regeneration of conjunctival epithelium on the Tenon layer always occurred rapidly, the cornea was completely covered by new epithelium in only a few cases: an artificial epithelium was therefore applied early in most patients. After tenonplasty and application of an artificial epithelium high local doses of corticosteroids can be given to suppress reactive inflammation and prevent neovascularization of the cornea.