{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:45:06Z","timestamp":1787071506354,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Corneal perforations following an acute suppurative ulcerative keratitis are usually technically challenging to fix, particularly when the corneal defects are very large. We present an alternative surgical technique using a combined tenon patch graft (TPG) and a conjunctival flap. A 33-year-old male presented with 8 and 10 mm paracentral corneal defects in the right and left eyes, respectively, following a 3-week history of bilateral suppurative ulcerative keratitis. A tenon\u2019s tissue was harvested from each eye and sutured to cover the perforation, and a conjunctival pedicle flap was then created and advanced over the tenon graft. Parenteral and topical medications were administered postoperatively. Serial clinical follow-up was conducted to document healing. At first day postsurgery, the uncorrected visual acuity (UCVA) was 6\/60 and the anterior chamber was formed. At discharge, conjunctivo-tenon graft\/flap was intact, the eyeball was stable, and UCVA was 6\/36 and 6\/24 in the right eye and left eye, respectively. By 3 months postsurgery, the globe and conjunctivo-tenon graft\/flap had further stabilized with UCVA of 6\/18 and 6\/12, respectively. At 6 months, the conjunctivo-tenon graft\/flap was stable with UCVA of 6\/18 and 6\/12, respectively. With spectacle lenses correction, the vision was 6\/9 (right eye) and 6\/6 (left eye). Combined autologous TPG and conjunctival advancement pedicle flap is a viable alternative in restoring the structural and functional integrity of an eye following a peripherally located large corneal perforation.<\/jats:p>","DOI":"10.4103\/njcp.njcp_304_25","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:00:36Z","timestamp":1764248436000},"page":"1235-1240","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Combined Autologous Tenon Patch Graft and Conjunctival Advancement Pedicle Flap in the Management of Bilateral Large Corneal Perforations"],"prefix":"10.4103","volume":"28","author":[{"given":"EI","family":"Ezeh","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University of Calabar, Abakaliki, Ebonyi, Nigeria"},{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SN","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Calabar, Abakaliki, Ebonyi, Nigeria"},{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ED","family":"Nkanga","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Calabar, Abakaliki, Ebonyi, Nigeria"},{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RN","family":"Ezeh","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"VA","family":"Eduvie","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NM","family":"Etiowo","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MP","family":"Ngaji","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"VU","family":"Ekpe","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BE","family":"Oguche","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Calabar Teaching Hospital, Abakaliki, Ebonyi, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"R2-20260420","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/ijo.IJO_1151_19","article-title":"Management of corneal perforations: An update","volume":"68","author":"Deshmukh","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"R3-20260420","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.survophthal.2011.06.003","article-title":"Management of corneal perforation","volume":"56","author":"Jhanji","year":"2011","journal-title":"Surv Ophthalmol"},{"key":"R4-20260420","doi-asserted-by":"crossref","first-page":"4257","DOI":"10.4103\/ijo.IJO_1279_22","article-title":"Clinical outcome and course of Tenon\u2019s patch graft in corneal perforation and descemetocele","volume":"70","author":"Kusumesh","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"R5-20260420","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1080\/08820538.2021.2017470","article-title":"Tenon\u2019s patch graft: A review of indications, surgical technique, outcomes and complications","volume":"37","author":"Kate","year":"2022","journal-title":"Semin Ophthalmol"},{"key":"R6-20260420","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1038\/sj.eye.6701814","article-title":"Superior forniceal conjunctival advancement pedicles (SFCAP) in the management of acute and impending corneal perforations","volume":"20","author":"Sandinha","year":"2006","journal-title":"Eye (Lond)"},{"key":"R8-20260420","doi-asserted-by":"crossref","first-page":"e1221","DOI":"10.1016\/S2214-109X(17)30393-5","article-title":"Global causes of blindness and distance vision impairment 1990-2020: A systematic review and meta-analysis","volume":"5","author":"Flaxman","year":"2017","journal-title":"Lancet Glob Health"},{"key":"R9-20260420","doi-asserted-by":"crossref","first-page":"4114","DOI":"10.1167\/iovs.09-3507","article-title":"Causes of blindness and visual impairment in Nigeria: The Nigeria National Blindness and Visual Impairment Survey","volume":"50","author":"Abdull","year":"2009","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R11-20260420","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4103\/njo.njo_2_18","article-title":"Microbial keratitis\u2014a review of epidemiology, pathogenesis, ocular manifestations, and management","volume":"26","author":"Ezisi","year":"2018","journal-title":"Niger J Ophthalmol"},{"key":"R12-20260420","doi-asserted-by":"crossref","first-page":"158","DOI":"10.3109\/09286586.2011.595041","article-title":"Microbial keratitis in East Africa: Why are the outcomes so poor?","volume":"18","author":"Burton","year":"2011","journal-title":"Ophthalmic Epidemiol"},{"key":"R13-20260420","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/09286586.2019.1700533","article-title":"Epidemiology of microbial keratitis in Uganda: A cohort study","volume":"27","author":"Arunga","year":"2020","journal-title":"Ophthalmic Epidemiol"},{"key":"R14-20260420","doi-asserted-by":"crossref","first-page":"24","DOI":"10.4103\/tcmj.tcmj_191_17","article-title":"Modified conjunctival flap as a primary procedure for nontraumatic acute corneal perforation","volume":"30","author":"Sun","year":"2018","journal-title":"Tzu Chi Med J"},{"key":"R15-20260420","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1001\/archopht.1990.01070090041035","article-title":"Results of penetrating keratoplasty for the treatment of corneal perforations","volume":"108","author":"Nobe","year":"1990","journal-title":"Arch Ophthalmol"},{"key":"R16-20260420","doi-asserted-by":"crossref","first-page":"101","DOI":"10.4103\/ais.ais_44_18","article-title":"Early experience with penetrating keratoplasty in South-South Nigeria: Initial audit of indications and outcome","volume":"8","author":"Umana","year":"2018","journal-title":"Arch Int Surg"},{"key":"R17-20260420","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1097\/ICO.0000000000001955","article-title":"Tuck-in tenon patch graft in corneal perforation","volume":"38","author":"Sharma","year":"2019","journal-title":"Cornea"},{"key":"R18-20260420","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1097\/ICO.0000000000000808","article-title":"Tenon\u2019s patch graft in the management of large corneal perforations","volume":"35","author":"Korah","year":"2016","journal-title":"Cornea"},{"key":"R19-20260420","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/00061198-199812000-00011","article-title":"Use of autologous Tenon\u2019s capsule and scleral patch grafts for repair of excessively draining fistulas with leaking filtering blebs","volume":"7","author":"Morris","year":"1998","journal-title":"J Glaucoma"},{"key":"R21-20260420","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1136\/bjophthalmol-2018-312375","article-title":"Clinical presentation and management of corneal fistula","volume":"103","author":"Singhal","year":"2019","journal-title":"Br J Ophthalmol"},{"key":"R22-20260420","doi-asserted-by":"crossref","first-page":"bcr","DOI":"10.1136\/bcr-2017-222790","article-title":"Tenon patch graft for corneal fistula: A rare entity treated by a simple technique","volume":"2017","author":"Maharana","year":"2017","journal-title":"BMJ Case Rep"},{"key":"R23-20260420","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1097\/ICO.0000000000003068","article-title":"Tenon patch graft with vascularized conjunctival flap for management of corneal perforation","volume":"41","author":"Shekhawat","year":"2022","journal-title":"Cornea"},{"key":"R24-20260420","doi-asserted-by":"crossref","first-page":"106046","DOI":"10.1016\/j.ijscr.2021.106046","article-title":"Long term outcome of Tenon\u2019s patch graft in corneal perforation secondary to neurotrophic keratitis: A case report on a 4-year anatomical functional outcome","volume":"83","author":"Chaudhary","year":"2021","journal-title":"Int J Surg Case Rep"},{"key":"R25-20260420","doi-asserted-by":"crossref","first-page":"101322","DOI":"10.1016\/j.ajoc.2022.101322","article-title":"Gore-Tex- as an adjuvant to Tenon\u2019s patch graft for large perforated corneal ulcers during Covid times","volume":"25","author":"Anitha","year":"2022","journal-title":"Am J Ophthalmol Case Rep"},{"key":"R26-20260420","doi-asserted-by":"crossref","first-page":"3372","DOI":"10.1177\/11206721221078682","article-title":"Hitch suture assisted tuck in Tenon\u2019s patch graft for management of corneal perforations","volume":"32","author":"Bafna","year":"2022","journal-title":"Eur J Ophthalmol"},{"key":"R27-20260420","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/S0161-6420(01)00969-1","article-title":"Histologic findings after amniotic membrane graft in the human cornea","volume":"109","author":"Gris","year":"2002","journal-title":"Ophthalmology"},{"key":"R28-20260420","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3109\/08830185.2012.737877","article-title":"Corneal transplantation and immune privilege","volume":"32","author":"Niederkorn","year":"2013","journal-title":"Int Rev Immunol"},{"key":"R29-20260420","doi-asserted-by":"crossref","first-page":"3389","DOI":"10.1167\/iovs.16-21394","article-title":"Optical coherence tomographic imaging of posterior episclera and tenon\u2019s capsule","volume":"58","author":"Ohno-Matsui","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["Nigerian Journal of Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_304_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:47:09Z","timestamp":1787068029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_304_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/njcp.njcp_304_25","relation":{},"ISSN":["1119-3077","2229-7731"],"issn-type":[{"value":"1119-3077","type":"print"},{"value":"2229-7731","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]},"assertion":[{"value":"2025-05-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}