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Clinical presentation and management of corneal fistula
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  • Published on: 15 April 2019
    Comment on 'Clinical presentation and management of corneal fistula'
    • Dr Arjun Srirampur, Ophthalmic Surgeon Anand Eye Institute , Hyderabad, India
    • Other Contributors:
      • Dr Tarannum Mansoori, Ophthalmic Surgeon

    Dear Editor,
    We have read with great interest the article by Singhal et al 1 on 'Clinical presentation and management of corneal fistula'. The authors have rightly highlighted the point that failure to perform simple test like Seidel test in cases of corneal ulcer, can lead to missing the diagnosis of corneal fistula, which in turn can lead to serious complications like endophthalmitis, panophthalmitis and phthisis bulbi.
    One of the complications of persistent corneal fistula is the formation of anterior capsular cataract. It would have been more insightful if the authors had mentioned as to how many patients had developed anterior capsular cataract during follow up, as this can lead to a change in the future management of the eye.
    Also, the authors have not mentioned the type of anaesthesia for doing the procedure. As creating the grooves around perforation to tuck in the tenons graft is difficult due to the friability of corneal tissue, the type of anaesthesia has a bearing on the intra operative surgical procedure. As doing the technique in topical anaesthesia will be technically challenging and administration of peribulbar block could lead to extrusion of the intraocular contents or extension of the perforation.
    Although the study mentions the surgical technique for closing the fistula with a tenons patch graft, it does not mention the regimen of postoperative medical management.
    In the discussion, the authors have mentioned that...

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    Conflict of Interest:
    None declared.