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Clinical presentation and management of corneal fistula
  1. Deepali Singhal,
  2. Pranita Sahay,
  3. Prafulla Kumar Maharana,
  4. Sreelakshmi P Amar,
  5. Jeewan S Titiyal,
  6. Namrata Sharma
  1. Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Prafulla Kumar Maharana, Cornea and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India; drpraful13{at}


Purpose To describe the clinical features and management of corneal fistula in patients of healed keratitis.

Methods Medical records of all patients of healed keratitis presenting to the cornea clinic from November 2016 to September 2017 were reviewed. Eightcases of corneal fistula (six true fistulas, two closed fistulas) were identified. Six patients were managed with autologous tenon patch graft while two patients were managed medically. Various risk factors and treatment outcomes of corneal fistulisation were evaluated.

Results The patients included two patients of failed therapeutic keratoplasty (with resolved graft infection) and six patients of healed keratitis. The age of the patients ranged between 10 and 60 years. Five of the patients were male while three were female. The size of the fistula measured between 1 and 2 mm. A surrounding cystic area of diameter ranging between 1 and 4.5 mm was seen in all the patients. In all of the patients, the treating physician missed the diagnosis. Complete healing was noted at 6–8 weeks in all the patients who underwent tenon graft. One patient refused to undergo any surgery and was lost to follow-up. In another case, surgery was deferred due to uncontrolled hypertension and he developed anterior staphyloma subsequently.

Conclusion Corneal fistula can often be missed in an apparently healed perforated corneal ulcer. Tenon patch graft is an effective technique for the management of corneal fistula.

  • Tenon Patch
  • Patch Graft
  • Corneal Fistula

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  • Contributors DS has contributed in writing the manuscript and keeping data of all the patients. PS has contributed in collection of data and photographs of the cases. PKM was involved in conceptualisation of the study, performing surgery in all the cases and final drafting of the manuscript. SPA was involved in collection of data. JST was involved in final editing and preparation of manuscript. NS was involved in data analysis and proof reading of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Institutional Ethics Committee, All India Institute of Medical Sciences, New Delhi.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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