Slajd 1

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

              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.




                             30 days after surgery             70 days after surgery



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


* Bioethical Commitee of Warsaw Medical University Agreement
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

     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



     The patches were removed from the eye surface within 4 - 29 months
     after surgery.
* Bioethical Commitee of Warsaw Medical University Agreement
Some cases of our study
     Peripheral corneal perforation




                        80 years old woman with peripheral perforation(1)
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).




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 sclera
1.                      under the coniuctiva(2). After 29 months the patch
                        was removed. There was thin connective leyer over
                        the lesion (3).




     2.                                3.
  Results




* 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
       Conclusions:


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 irratation
          they 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.