Tenon patch graft repair in an unusual case of leaking wound after phacoemulsification

Abstract

Leaking corneal incisions after phacoemulsification can be associated with devastating consequences and can lead to secondary complications including endophthalmitis, choroidal hemorrhage, and glaucoma. We report a case of leaking corneal wound after routine phacoemulsification at the site of corneal thinning associated with terrien marginal degeneration (TMD), which was missed preoperatively, consequently leading to this surgical complication. TMD is a rare form of ectatic corneal condition with a very slow progression. The main aim of treatment is to improve the vision and corneal integrity, owing to its uncertain etiology. Surgical intervention in TMD, however, has been advocated when perforation is imminent, but the chance of spontaneous and intraoperative perforation increases in cases with severe thinning of corneas resulting in poor visual outcomes as compared to non-perforated eyes. In our case, as an amniotic membrane or corneal tissue was not available at the time of presentation, we proceeded with a Tenon patch graft with the application of cyanoacrylate glue, following which a bandage contact lens was applied. This case highlights the importance of a meticulous preoperative workup of the patient to identify any abnormality of the cornea, especially at the incision sites, to avoid such complications during the surgery.