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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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C.S. Ramesh Babu,
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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : ND01 - ND03 Full Version

Non Infectious Descemetocele Treated with a Surgical Drape Patch: A Case Report


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55925.16306
Nilay Rajendra Dhore, Shashi Prabha Prasad, Amod Ahuja, Kunj Shailesh Naik, Mayur Anil Patil

1. Junior Resident, Department of Ophthalmology, Dr D.Y.Patil Medical College Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. 2. Professor, Department of Ophthalmology, Dr D.Y.Patil Medical College Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. 3. Junior Resident, Department of Ophthalmology, Dr D.Y.Patil Medical College Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. 4. Junior Resident, Department of Ophthalmology, Dr D.Y.Patil Medical College Hospital and Research Centre, Pimpri, Pune, Maharashtra, India. 5. Junior Resident, Department of Ophthalmology, Dr D.Y.Patil Medical College Hospital and Research Centre, Pimpri, Pune, Maharashtra, India.

Correspondence Address :
Dr. Nilay Rajendra Dhore,
120, Sanje Evan Kalyan Nagar, Amravati, Maharashtra-444606, India.
E-mail: nilay.dhore@gmail.com

Abstract

A corneal descemetocele is the anterior herniation of an intact Descemet membrane through an overlying stromal defect. Though a rare complication, it is a serious one that needs to be treated at the earliest. If not treated promptly, it may result in a full-thickness corneal perforation which will hinder the ocular integrity and may end up with vision-threatening complications. Here, the authors report a case of a 58-year-old female patient who came to the Outpatient Department with complaints of redness and pain in the Right Eye (RE). The patient on examination had a descemetocele impending perforation of the right eye. On the initial visit, a bandage contact lens (BCL) was placed. On follow-up, after one week, the BCL was displaced due to undue rubbing of the eye by the patient, and on readjustment, it ended up with corneal perforation. As an emergency, treatment was required and due to a shortage of donor corneal tissue in the ongoing pandemic, a tectonic patch was made by trephining non-sticky part of sterile plastic drape which was available on-site and a double drape patch technique was performed. Both the patches were then placed over the perforation, which sealed the perforation completely. On a consecutive follow-up of one week and one month, the authors found the patch to be intact and maintaining ocular integrity. A tectonic drape patch technique is a viable and easy method of closing an open wound with nontraumatic corneal perforations when other methods to immediately seal the wound are not available.

Keywords

Cyanoacrylate glue, Corneal perforation, Descemet membrane, Double drape tectonic patch

Case Report

A 58-year-old female patient, a housewife, visited the Ophthalmology Outpatient Department, Dr D.Y.Patil Medical College Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, with complaints of pain in the Right Eye for two days, which was sudden in onset, progressive, continuous, sharp, and radiating to the forehead. The patient also complained of associated diminution of vision, intolerance to light, redness, and watering in the right eye which was also sudden in onset and progressive in nature with no aggravating or relieving factors. There was no history of any sticky discharge from the eye, no itching, and no history of any mechanical or chemical trauma that the patient could recall. Also, there was no history of instillation of any eye drops. The patient gave a history of Right eye cataract surgery done 12 years back and Left Eye (LE) cataract surgery 2 years back which were uneventful.

The general examination was within normal limits. On ocular examination, (RE) vision was reduced to 6/36 not showing any improvement by pinhole on Snellen’s Visual acuity and near vision N/12. The Left Eye (LE) Best Corrected Visual Acuity (BCVA) was 6/9 and near vision was N/6. On slit-lamp examination of the RE, Anterior segment showed circumcorneal congestion, a circular area of approximately 1.5×1.5 mm with approximately 80 percent thinning present. This area was surrounded by folds in the Descemet’s membrane with stromal haze present. Superficial punctate keratopathy was present all over the cornea. Iris pigments were present on the endothelium. The anterior chamber was deep and showed no cells and flare. A paracentral area at 6:30 O’clock position not taking up a stain was noted. (Table/Fig 1), (Table/Fig 2) The seidel’s test was negative. Posterior Chamber Intraocular Lens was placed in-situ; and the posterior segment examination showed, Optic disc was within normal limits, Macula was normal with dull foveal reflex, and the peripheral fundus appeared hazily within normal limits.

On examination of LE, the anterior segment examination on the slit lamp showed no abnormalities and a posterior chamber intraocular lens was placed in-situ. The posterior segment examination showed optic disc within normal limits, macula was normal with a dull foveal reflex and peripheral fundus was also within normal limits. Intraocular pressure (IOP) of RE was not recorded as the corneal integrity was compromised, IOP of LE was 14 mm Hg. An Anterior Segment Optical Coherence Tomography (AS-OCT) imaging of the right eye was done which showed marked thinning of the cornea. (Table/Fig 3).

All routine investigations were done and the results were within normal limits. The Rheumatoid Arthritis (RA) Factor, Antinuclear Antibodies (ANA) was within normal limits and the patient was seronegative. Chest X-Ray and X-Ray Lumbosacral Spine were normal. The patient was prescribed regular medical treatment with topical antibiotics, lubricants, and a cycloplegic with IOP lowering medications. A Bandage Contact Lens (BCL) (Contasof EW, Care group sight solutions, India) was placed. (Table/Fig 4) On the first follow up after one week, an intense anterior chamber reaction was noted with the formation of the pupillary membrane and a displaced bandaged contact lens was noted. On further enquiry, the patient confessed that she rubbed the eye. On readjusting the bandaged contact lens, the Descemetocele perforated with the iris plugged the perforation (Table/Fig 5).

As an emergency treatment was required and due to a shortage of donor corneal tissue in the ongoing pandemic, a tectonic patch made by trephining Spunbond/Meltblown/Spunbond (SMS) Polypropylene fabric was placed over the perforation. (Table/Fig 6) The patient was also started on oral steroids with tapering dosage and topical antibiotics and homatropine eye drops. The patient was asked to follow up after one week. On presentation, the visual acuity was hand movement close to face, Projection of Rays (PR) accurate, and anterior chamber reaction was reduced along with circumcorneal congestion. At one month follow up, the patient elicited a visual acuity of 6/60 according to Snellen’s visual acuity chart. It also showed that the drape material was biocompatible and maintained ocular integrity.

Discussion

The anterior herniation of an intact Descemet membrane (DM) through an overlying stromal defect is called a corneal descemetocele. Though it is a rare complication, it is a serious one (1). In this uncommon but serious complication of corneal ulceration, the stroma thins to such an extent that only the DM maintains the integrity of the globe (2),(3),(4). Although causes of descemetocele may include collagen vascular diseases, autoimmune disorders, rheumatoid arthritis, ocular pemphigoid, local irradiation, in cases with trauma and Mooren ulcers (5),(6), but in the present case, a specific local or a systemic cause even after testing for systemic causes could not be ascertained.

A full-thickness corneal perforation can result if the conditions are not treated promptly. Jyoti Deswal et al. reported a case of bilateral corneal perforation in a patient with a severe dry eye disease which was treated using a sterile plastic sheet, cyanoacrylate glue, and a BCL (Bandage contact lens) was placed over it which showed promising results (7). A case of sterile corneal perforation in a 20-year-old Indian male with severe dry eye disease was reported by Baranwal VK et al., (8). Four patients with chronic graft-versus-host disease with dry eye who suffered corneal perforation have been reported by Inagaki E et al., (9).

Corneal perforation is classified as traumatic or nontraumatic, with nontraumatic causes classified as infectious or non infectious (10). The most common non-traumatic cause of corneal perforation is Keratoconjunctivitis sicca, although, exposure to keratopathy, neurotrophic keratitis, herpes simplex keratitis, and bacterial keratitis can all lead to perforation (10),(11). Using a BCL(Bandage contact lens) with or without cyanoacrylate glue (12),(13). Cryopreserved amniotic membrane patch with or without fibrin glue, (14),(15) and partial (lamellar or tectonic) and full-thickness keratoplasty operations are some of the therapeutic approaches, (11). In a perforation of less than 1 mm in diameter, the cyanoacrylate glue can be an effective modality of treatment if the perforation is located away from the limbus and is concave in shape (10). Sometimes a clinical scenario might arise, in which the traditional methods to seal the perforation with glues, amniotic membrane grafts, or corneal tissue are not available, then the options for sealing the corneal perforations and maintaining the ocular integrity are very limited. It is vital to diagnose and treat nontraumatic corneal perforations immediately to prevent complications such as endophthalmitis, corneal decompensation, glaucoma, and cataract. In non-traumatic perforations, tissue loss in the cornea can make management more difficult than in lacerations with traumatic wounds.

Various techniques for applying cyanoacrylate glue have been proposed (13). One method involves cutting out a piece of drape and applying a lubricant jelly to the cotton swab; then the cyanoacrylate glue is applied to the other side. This is done by applying cyanoacrylate glue to the surface of the drape.(13) Another technique that was reported was fabricating a sterile surgical drape into a tectonic patch that was applied directly to the perforation instead of the glue (16). Our system used a skin punch to cut a 2 mm diameter and a 3 mm diameter disc from the nonsticky part of the sterile surgical drape (SMS Polypropylene fabric). The 3 mm disc was first centered on the corneal perforation to protect the iris. The larger patch was then glued over the 3 mm patch and covered with a therapeutic bandaged contact lens, this technique was also reported by Gandhewar J et al., (17).

Cryopreserved amniotic membrane and fibrin glue were used in the sealing of non infectious corneal perforations by Duchesne B et al., (14). Taking into consideration that fibrin glue may potentiate bacterial and fungal infections, it is important to avoid it for these kinds of cases. Nevertheless, fibrin glue may aid corneal healing by stimulating the production of scar tissue. However, some authors have reported that cyanoacrylate glue is bacteriostatic (13). Both types of glues are well tolerated by the corneal tissue. In some clinical scenarios, corneal tissue is not available on-demand for sealing of the corneal perforations, and cyanoacrylate glue may not hold and even fail before a corneal tissue is available for further treatment. Many surgeons prefer to use glue as a temporizing measure rather than penetrating or lamellar keratoplasty procedures, which are ideally carried out when the eye is stable and inflammation is minimal (18). This case shows a relatively less used method of how a tectonic double drape patch with cyanoacrylate glue could help restore the integrity of the eye. There is no known maximum size of perforation for which tectonic drape patching can be utilized, but we managed to patch the perforation successfully using this method, and this temporary measure was well tolerated. This measure kept the eye stable for a period of 1 month. On follow-up of 1-month, clinical examination showed that the drape material was favourable, durable, non-immunogenic, maintained the ocular integrity of the globe and we could salvage a visual acuity of 6/60 on Snellen’s visual acuity chart.

Conclusion

A tectonic drape patch technique is a viable and easy method of closing an open wound with nontraumatic corneal perforations, when other methods to immediately seal the wound like using bandaged contact lens with cyanoacrylate glue have failed and in cases of unavailability of amniotic membrane graft or corneal tissue, as observed in the present case due to the ongoing pandemic situation.

References

1.
Twining SS, Davis SD, Hyndiuk RA. Relationship between proteases and descemetocele formation in experimental Pseudomonas keratitis. Current eye research. 1986 Jan 1;5(7):503-10. [crossref] [PubMed]
2.
Can ME, Can GD, Cagil N, Cakmak HB, Sungu N. Urgent therapeutic grafting of platelet-rich fibrin membrane in descemetocele. Cornea. 2016 Sep 1;35(9):1245-9. [crossref] [PubMed]
3.
Gabison EE, Doan S, Catanese M, Chastang P, M'hamed MB, Cochereau I. Modified deep anterior lamellar keratoplasty in the management of small and large epithelialized descemetoceles. Cornea. 2011 Oct 1;30(10):1179-82. [crossref] [PubMed]
4.
Yap YC, Mandalia P, Brien PO, Barampouti F, Kodati S. Descemetocoele from exposure keratopathy. Annals of Ophthalmology. 2007 Jul;39(3):259-60. [crossref] [PubMed]
5.
Petroutsos G, Paschides CA, Kitsos G, Skopouli FN, Psilas K. Sterile corneal ulcers in dry eye. Incidence and factors of occurrence. J Fr Ophtalmol. 1992;15(2):103-05.
6.
Hemady R, Chu W, Foster CS. Keratoconjunctivitis sicca and corneal ulcers. Cornea. 1990;9(2):170-73. [crossref] [PubMed]
7.
Deswal J, Arya SK, Raj A, Bhatti A. A Case of Bilateral Corneal Perforation in a Patient with Severe Dry Eye. J Clin Diagn Res. 2017 Apr;11(4):ND01-ND02. doi: 10.7860/JCDR/2017/24149.9645. Epub 2017 Apr 1. PMID: 28571178; PMCID: PMC5449824.
8.
Baranwal VK, Satyabala K, Mishra A, Dutta AK. Sterile corneal perforations in a case of severe dry eyes. Med J Armed Forces India. 2015;71(3):290-92. [crossref] [PubMed]
9.
Inagaki E, Ogawa Y, Matsumoto Y, Kawakita T, Shimmura S, Tsubota K. Four cases of corneal perforation in patients with chronic graft-versus-host disease. Mol Vis. 2011;17:598-606. PMID: 21386923
10.
Lekskul M, Fracht HU, Cohen EJ, Rapuano CJ, Laibson PR. Nontraumatic corneal perforation. Cornea. 2000 May 1;19(3):313-9. [crossref] [PubMed]
11.
Sukhija J, Jain AK. Outcome of therapeutic penetrating keratoplasty in infectious keratitis. Ophthalmic Surgery, Lasers and Imaging Retina. 2005 Jul 1;36(4):303-9. [crossref]
12.
Chan SM, Boisjoly H. Advances in the use of adhesives in ophthalmology. Current opinion in ophthalmology. 2004 Aug 1;15(4):305-10. [crossref] [PubMed]
13.
Vote BJ, Elder MJ. Cyanoacrylate glue for corneal perforations: a description of a surgical technique and a review of the literature. Clinical & experimental ophthalmology. 2000 Dec;28(6):437-42. [crossref] [PubMed]
14.
Duchesne B, Tahi H, Galand A. Use of human fibrin glue and amniotic membrane transplant in corneal perforation. Cornea. 2001 Mar 1;20(2):230-2. [crossref] [PubMed]
15.
Rodríguez-Ares MT, Touriño R, López-Valladares MJ, Gude F. Multilayer amniotic membrane transplantation in the treatment of corneal perforations. Cornea. 2004 Aug 1;23(6):577-83. [crossref] [PubMed]
16.
Khalifa YM, Bailony MR, Bloomer MM, Killingsworth D, Jeng BH. Management of nontraumatic corneal perforation with tectonic drape patch and cyanoacrylate glue. Cornea. 2010 Oct 1;29(10):1173-5. [crossref] [PubMed]
17.
Gandhewar J, Savant V, Prydal J, Dua H. Double drape tectonic patch with cyanoacrylate glue in the management of corneal perforation with iris incarceration. Cornea. 2013 May 1;32(5):e137-8. [crossref] [PubMed]
18.
Soong HK, Farjo AA, Katz D, Meyer RF, Sugar A. Lamellar corneal patch grafts in the management of corneal melting. Cornea. 2000 Mar 1;19(2):126-34. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55925.16306

Date of Submission: Feb 26, 2022
Date of Peer Review: Mar 18, 2022
Date of Acceptance: Apr 13, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 03, 2022
• Manual Googling: Mar 30, 2022
• iThenticate Software: Apr 01, 2022 (9%)

ETYMOLOGY: Author Origin

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