Department of OphthalmologyMedical University of Warsaw, Poland

Expanded Polytetrafluoroethylene Patches to Treat Ocular Surface Disorders

Dorota Kopacz MD, PhD, Piotr Maciejewicz MD, PhD, Dariusz Kęcik MD, PhD

Authors have no financial interest

In 1969 Bob Gore invented new form –”expanded” – of politetrafluoroethylene (ePTFE), which quickly spread in many devices of new technologies.

In medicine ePTFE is well-known in cardiosurgery, neurosurgery, soft, vascular and plastic surgery, traumathology.

In ophthalmology ePTFE was described in studies for retinal detachment, glaucoma, corneal and palpebral surgery.

30 days after surgery 70 days after surgery

In the nineties of last century we performed experimental study with ePTFE for buckling surgery of retinal detachment.

Results of that study were the start point for useing ePTFE patches to treat ocular surface disorders.

* Bioethical Commitee of Warsaw Medical University Agreement

Very good biotolerance for ePTFE with mild inflamation in the place of surgery was observed. The histopathological examination revealed „round foreign body reaction”. About 4 weeks after surgery thin connective tissue layer was observed round the ePTFE implants.

The aim of the presented study:

clinical evaluation of the ePTFE patches for the ocular surface disorders surgical

treatment

Material, methods

Patients with lesions of ocular surface:* small peripheral corneal perforations 2 cases* corneal melting 3 cases* scleromalatia 2 cases

The patches were removed from the eye surface within 4 - 29 months after surgery.

Described lesions, getting worse inspite of topical and oral treatment, were covered with the e-PTFE patches (small porous, cardiovascular patch*) and clinical observations were performed.

ePTFE patch

* Bioethical Commitee of Warsaw Medical University Agreement

Some cases of our study

Peripheral corneal perforation

80 years old woman with peripheral perforation(1)in the course of corneal ulcer was admitted to our clinic.During surgery iris was replaced, single suture made wound edges closer and ePTFE patch was sutured over the lesion. 20 weeks later patch was removed from the eye surface. No signs of inflamation, deep anterior chamber and healed lesion were noted (2).

1.

2.

Corneomalatio

30 years old woman came to our clinic with corneal ulcer.After treatment, leucoma with neovascularisation was observed and corneal transplantation was performed. Within 3 months after surgery corneal melting was noted and ePTFE patch was sutured over the whole cornea (1). After removig ePTFE patch, no melting and inflamation under the patch were observed(2).

1. 2.

Scleromalatio perforans

77 years old woman with long-lasting reumatoidal artritis was admitted to our clinic because of really thin sclera in course of sleromalatio perforans(1). In past: iridocyclitis and cataract surgery of both eyes.We covered the lesion with ePTFE patch sutured to the scleraunder the coniuctiva(2). After 29 months the patch was removed. There was thin connective leyer over the lesion (3).

1.

2. 3.

* there was no problem to remove ePTFE patch from the eye surface* in all cases the observed lesions healed under the e-PTFE patch* thin connective tissue layer was observed under the patch in the place of the surgery

Results

The group of the study is too small for any statistical analysis – we treat it as a preliminary data. Our results sugest that:

* the ePTFE patches play double role in the study: they are mechanical protection against external irratationthey trigger off „round foreign body reaction” with thin connective tissue layer over the lesion

* in connection with topical and general treatment they seem to be an alternative way for the ocular surface disorders surgical treatment.

Conclusions: