Review of Patch Graft Uses in Ophthalmology
Main Article Content
Abstract
The use of patch grafts in the field of ophthalmology has continued to evolve over the last century. Patch grafts are invaluable to reinforce ocular structures, protect implants, facilitate healing, and more. Corneal and scleral tissues, pericardium, dura mater, and amniotic membrane have historically been used as materials for patch grafts. Each material provides its own variation in tensile strength, immunogenicity, resorption, and cosmesis. These variations are important to consider when selecting a graft for a wide variety of conditions, including corneal perforation and melt, scleral melt, and the covering of glaucoma drainage device tubes. The selection of a graft material is also often influenced by the clinical scenario, cost, availability and surgeon preference.
Corneal and scleral grafts have remained a common choice due to their low rejection rates and known structural integrity. Amniotic membrane grafts are notable due to their anti-inflammatory properties and are commonly used in an adjunctive fashion. Tenon’s patch graft is a relatively new option that has gained popularity due to accessibility, affordability, success rates, and lack of rejection due to its autologous nature. Multiple comparative studies have shown no significant difference in exposure rates for donor sclera, cornea, and pericardium when used in glaucoma drainage device surgery.
Biodegradable materials like Ologen (Aeon Astron Leiden,The Netherlands) and synthetic grafts, such as polytetrafluoroethylene, may represent innovative alternatives to traditional tissue grafts. There is now a newer alternative option, CorNeat EverPatch (CorNeat Vision, Ra’anan, Israel. Ongoing evaluations and research are needed to continue evaluating efficacy, accessibility, cosmetic outcomes, complications, and healthcare costs as surgical techniques and material sciences advance over time.
Article Details
How to Cite
JOHNSON, Sandra M.; BLANTON, William Brady.
Review of Patch Graft Uses in Ophthalmology.
Medical Research Archives, [S.l.], v. 13, n. 7, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6753>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6753.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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7. Raviv T, Greenfield DS, Liebmann JM, Sidoti PA, Ishikawa H, Ritch R. Pericardial patch grafts in glaucoma implant surgery. J Glaucoma. 1998 ;7(1):27-32. PMID: 9493112.
8. Hashemi H, Asgari S, Shahhoseini S, Mahbod M, Atyabi F, et al. Application of polycaprolactone nanofibers as patch graft in ophthalmology. Indian J Ophthalmol. 2018;66(2):225-8. doi: 10.4103/ijo.IJO_647_17. PMID: 29380763; PMCID: PMC5819100.
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19. Kusumesh R, Kishore A, Venugopal A, Shah SG, Vanathi M. Clinical application and outcome of Tenon's patch graft: A comprehensive review. Indian J Ophthalmol. 2024 ;72(12):1714-20. doi: 10.4103/IJO.IJO_783_24. Epub 2024 Aug 14. PMID: 39186621; PMCID: PMC11727946.
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22. Casas VE, Kheirkhah A, Blanco G, Tseng SC. Surgical approach for scleral ischemia and melt. Cornea. 2008 Feb;27(2):196-201. doi: 10.1097/ICO.0b013e318 15ba1ae. PMID: 18216576.
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27. Burcu A, Yalnız-Akkaya Z, Şingar Özdemir E, Özbek-Uzman S. Donor cornea use in scleral surface reconstruction. Turk J Ophthalmol. 2021;51(4):192-8. doi: 10.4274/tjo.galenos.2020.27116. PMID: 34461694; PMCID: PMC8411283.
28. Jabbour S, Lesk, MR, Harissi-Dagher M, Patch graft using collagen matrix (Ologen) for glaucoma drainage device exposure in a patient with Boston Keratoprosthesis type 1. Am J of Ophthal Case Reports 2018;12: 32-5, ISSN 2451-9936, https://doi.org/10.1016/j.ajoc.2018.08.003. (https://www.sciencedirect.com/science/article/pii/S2451993617303924
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34. Alio JL, Montesel A, El Sayyad F, Barraquer RI, Arnalich-Montiel F, Alio Del Barrio JL. Corneal graft failure: an update. Br J Ophthalmol 2021 Aug;105(8):1049-58. doi: 10.1136/bjophthalmol-2020-316705. Epub 2020 Aug 11. PMID: 32788325.
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37. Korah S, Selvin SS, Pradhan ZS, Jacob P, Kuriakose T. Tenons patch graft in the management of large corneal perforations. Cornea2016;35:6969. doi: 10.1097/ICO.0000000000000808.
38. Kusumesh R, Ambastha A, Singh A, Kumari D, Mohan N, Sinha BP, Arya LK. Clinical outcome and course of Tenon's patch graft in corneal perforation and descemetocele. Indian J Ophthalmol. 2022 70(12):4257-62. doi: 10.4103/ijo.IJO_1279_22. PMID: 36453327; PMCID: PMC9940507
39. Kusumesh R, Kishore A, Venugopal A, Shah SG, Vanathi M. Clinical application and outcome of Tenon's patch graft: A comprehensive review. Indian J Ophthalmol. 2024;72(12):1714-20. doi: 10.4103/IJO.IJO_783_24. Epub 2024 Aug 14. PMID: 39186621; PMCID: PMC11727946.
40. Suzuki T, Yamaguchi T, Tomida D, Fukui M, Shimazaki J. Outcome of Lamellar Graft Patching for the Treatment of Noninfectious Corneal Perforations. Cornea. 2022;41(9):1122-8. doi: 10.1097/ICO.0000000000002926. Epub 2021 Nov 22. PMID: 34812781; PMCID: PMC9365251.
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2. Siva Jyothi, E Lalitha; Gopala Krishna, O1; Lakshmana Rao, P2; Raja Sekhar, P3. Case series of scleral patch grafts during COVID-19 pandemic. Indian Journal of Ophthalmology 2021;69(9): 2530-2. | DOI: 10.4103/ijo.IJO_3784_20
3. de Rotta A. Plastic repair of conjunctival defects with fetal membranes. Arch Ophthalmol. 1940;23(3):522–5. doi:10.1001/archopht.1940.00860130586006
4. Walkden A. Amniotic membrane transplantation in ophthalmology: An updated perspective. Clin Ophthalmol. 2020 Jul 22;14:2057-72. doi: 10.2147/OPTH.S208008. PMID: 32801614; PMCID: PMC7383023.
5. Van Horn DL, Schultz RO. Corneal preservation: recent advances. Surv Ophthalmol. 1977 Jan-Feb;21(4):301-12. doi: 10.1016/0039-6257(77)90112-6. PMID: 835080.
6. Hamaguchi T, Sakai K, Noguchi-Shinohara M, Nozaki I, Takumi I, Sanjo N, et al. Insight into the frequent occurrence of dura mater graft-associated Creutzfeldt-Jakob disease in Japan. J Neurol Neurosurg Psychiatry. 2013; 84(10):1171-5. doi: 10.1136/jnnp-2012-304850. Epub 2013 Apr 17. PMID: 23595947.
7. Raviv T, Greenfield DS, Liebmann JM, Sidoti PA, Ishikawa H, Ritch R. Pericardial patch grafts in glaucoma implant surgery. J Glaucoma. 1998 ;7(1):27-32. PMID: 9493112.
8. Hashemi H, Asgari S, Shahhoseini S, Mahbod M, Atyabi F, et al. Application of polycaprolactone nanofibers as patch graft in ophthalmology. Indian J Ophthalmol. 2018;66(2):225-8. doi: 10.4103/ijo.IJO_647_17. PMID: 29380763; PMCID: PMC5819100.
9. Jacob T, LaCour OJ, Burgoyne CF, LaFleur PK, Duzman E. Expanded polytetrafluoroethylene reinforcement material in glaucoma drain surgery. J Glaucoma. 2001;10(2):115-20. doi: 10.1097/00061198-200104000-00008. PMID: 11316093.
10. Kanter J, Garkal A, Cardakli N, Pitha I, Sabharwal J et al. Early postoperative conjunctival complications leading to exposure of surgically implanted CorNeat EverPatch devices. Ophthalmology 2025; Mar 3:S01616420(25)00141-1. doi: 10.1016/j.ophtha.2025.02.020. Epub ahead of print. PMID: 40044047.
11. Rosentreter A, Schild A, Dinslage S, Dietlein T S. Biodegradable implant for tissue repair after glaucoma drainage device surgery. Journal of Glaucoma 2012;21(2): 76-8. | DOI: 10.1097/IJG.0b013e3182027ab0
12. Sharma S, Rathi A, Murthy SI, Trivedi M, Patel C, et al. Outcomes of penetrating and lamellar corneal patch grafts. Cornea. 2021; 40(5):618-23. doi: 10.1097/ICO.0000000000002529. PMID: 33055550.
13. Schaab G, Clavell C, Himani GH.Corneal Patch Grafts: A review of the indications, techniques, and success rates. Invest. Ophthalmol Vis. Sci. 2012;53(14):6044.
14. Asfuroğlu Y, Karaca EE, Orman C, Evren Kemer Ö. Clinical and surgical outcomes of tectonic corneal patch grafts: insights from a tertiary referral hospital. BMC Ophthalmol. 2024;24(1):516. doi: 10.1186/s12886-024-03782-2. PMID: 39614205; PMCID:PMC11607979
15. Sainz de la Maza M, Tauber J, Foster CS. Scleral grafting for necrotizing scleritis. Ophthalmology. 1989;96(3):306-10. doi: 10.1016/s0161-6420(89)32892-2. PMID: 2710520.
16. Jung YH, Yoon CH, Kim MK. Preserved corneal lamellar transplantation for infectious and noninfectious scleral defects: Three case reports and literature review. Medicine (Baltimore). 2021 Jul 23;100(29):e26607. do10.1097/MD.0000000000026607. PMID:34398015; PMCID: PMC8294895.
17. Aggarwal S, Kremer C, Engelhard S, Johnson S. Comparison of locally sourced pericardium and other conventional patch graft materials in glaucoma drainage device surgery. J Curr Glaucoma Pract. 2021;15(1):14-8. doi: 10.5005/jp-journals-10078-1294. PMID:34393451; PMCID: PMC8322593.
18. Thakak S, Ichhpujani P, Kumar S. Grafts in glaucoma surgery: A Review of the Literature, Asia-Pacific J Ophthalmol 2017; 6(5): 469-76. ISSN 21620989,https://doi.org/10.22608/APO.2016123
19. Kusumesh R, Kishore A, Venugopal A, Shah SG, Vanathi M. Clinical application and outcome of Tenon's patch graft: A comprehensive review. Indian J Ophthalmol. 2024 ;72(12):1714-20. doi: 10.4103/IJO.IJO_783_24. Epub 2024 Aug 14. PMID: 39186621; PMCID: PMC11727946.
20. Sharma N, Singhal D, Maharana PK, Vajpayee RB. Tuck-In Tenon Patch Graft in Corneal Perforation. Cornea. 2019; (8):951-4. doi:10.1097/ICO.0000 000000001955. PMID: 31276458.
21. Soong HK, Farjo AA, Katz D, Meyer RF, Sugar A. Lamellar corneal patch grafts in the management of corneal melting. Cornea. 2000;19(2):126-34. doi: 10.1097/00003226-200003000-00002. PMID: 10746441.
22. Casas VE, Kheirkhah A, Blanco G, Tseng SC. Surgical approach for scleral ischemia and melt. Cornea. 2008 Feb;27(2):196-201. doi: 10.1097/ICO.0b013e318 15ba1ae. PMID: 18216576.
23. Dang DH, Riaz KM, Karamichos D. Treatment of Non-Infectious Corneal Injury: Review of diagnostic agents, therapeutic medications, and future targets. Drugs. 2022 Feb;82(2):145-167. doi: 10.1007/s40265-021-01660-5. Epub 2022 Jan 13. PMID: 35025078; PMCID: PMC8843898.
24. Gomes, José AP, et al. "Amniotic membrane use in ophthalmology." Current opinion in ophthalmology 2005;16.4: 233-40.
25. Patel NV, Aggarwal M, Jain M, Gour A, Sangwan V. DealingwWith pericylindrical melts in keratoprosthesis: tenon patch graft to the rescue. Cornea. 2024; 43(5):641-3. doi: 10.1097/ICO.0000 000000003501. Epub 2024 Feb 20. PMID: 38377401
26. Sangwan, V., Jain, V. & Gupta, P. Structural and functional outcome of scleral patch graft. Eye 2007; 21: 930–5. https://doi.org/10.1038/sj.eye.6702344
27. Burcu A, Yalnız-Akkaya Z, Şingar Özdemir E, Özbek-Uzman S. Donor cornea use in scleral surface reconstruction. Turk J Ophthalmol. 2021;51(4):192-8. doi: 10.4274/tjo.galenos.2020.27116. PMID: 34461694; PMCID: PMC8411283.
28. Jabbour S, Lesk, MR, Harissi-Dagher M, Patch graft using collagen matrix (Ologen) for glaucoma drainage device exposure in a patient with Boston Keratoprosthesis type 1. Am J of Ophthal Case Reports 2018;12: 32-5, ISSN 2451-9936, https://doi.org/10.1016/j.ajoc.2018.08.003. (https://www.sciencedirect.com/science/article/pii/S2451993617303924
29. Weissgold DJ, Millay RH, Bochow TA. Rescue of exposed scleral buckles with cadaveric pericardial patch grafts. Ophthalmology 2001; 08(4): 753-8.
30. De Francesco T, Ianchulev T, Rhee DJ, Gentile RC, Pasquale LR, Ahmed IIK. The evolving surgical paradigm of scleral allograft bio-tissue use in ophthalmic surgery: techniques and clinical indications for ab-externo and ab-interno scleral reinforcement. Clin Ophthalmol. 2024 Jun 21;18:1789-95. doi: 10.2147/OPTH.S462719. PMID: 38919403; PMCID: PM
31. Tang M, Ward D, Ramos JL, Li Y, Schor P, Huang D. Measurements of microkeratome cuts in donor corneas with ultrasound and optical coherence tomography. Cornea 2012; Feb;31(2):145-9. doi: 10.1097/ICO.0b013e318221cef8. PMID: 22157571; PMCID: PMC3259255.
32. Mobaraki M, Abbasi R, Omidian VS, Ghaffari M, Moztarzadeh F, Mozafari M. Corneal repair and regeneration: Current concepts and future directions. Front Bioeng Biotechnol. 2019: Jun 11;7:135. doi: 10.3389/fbioe.2019.00135. PMID: 31245365; PMCID: PMC6579817.
33. Norman RE, Flanagan JG, Sophie M.K. Rausch IA, Sigal IT, et al. Ethier, Dimensions of the human sclera: Thickness measurement and regional changes with axial length, Experimental Eye Research, Volume 90, Issue 2, 2010, Pages 277-84, ISSN 0014-4835, https://doi.org/10.1016/j.exer.2009.11.001. https://www.sciencedirect.com/science/article/pii/S0014483509003194
34. Alio JL, Montesel A, El Sayyad F, Barraquer RI, Arnalich-Montiel F, Alio Del Barrio JL. Corneal graft failure: an update. Br J Ophthalmol 2021 Aug;105(8):1049-58. doi: 10.1136/bjophthalmol-2020-316705. Epub 2020 Aug 11. PMID: 32788325.
35. Niederkorn JY. The immune privilege of corneal grafts. J Leukoc Biol. 2003 Aug;74(2):167-71. doi: 10.1189/jlb.1102543. PMID:12885932.
36. Lankaranian D, Reis R, Henderer JD, Choe S, Moster MR. Comparison of single thickness and double thickness processed pericardium patch graft in glaucoma drainage device surgery. J Glaucoma 2008;17:48–51.
37. Korah S, Selvin SS, Pradhan ZS, Jacob P, Kuriakose T. Tenons patch graft in the management of large corneal perforations. Cornea2016;35:6969. doi: 10.1097/ICO.0000000000000808.
38. Kusumesh R, Ambastha A, Singh A, Kumari D, Mohan N, Sinha BP, Arya LK. Clinical outcome and course of Tenon's patch graft in corneal perforation and descemetocele. Indian J Ophthalmol. 2022 70(12):4257-62. doi: 10.4103/ijo.IJO_1279_22. PMID: 36453327; PMCID: PMC9940507
39. Kusumesh R, Kishore A, Venugopal A, Shah SG, Vanathi M. Clinical application and outcome of Tenon's patch graft: A comprehensive review. Indian J Ophthalmol. 2024;72(12):1714-20. doi: 10.4103/IJO.IJO_783_24. Epub 2024 Aug 14. PMID: 39186621; PMCID: PMC11727946.
40. Suzuki T, Yamaguchi T, Tomida D, Fukui M, Shimazaki J. Outcome of Lamellar Graft Patching for the Treatment of Noninfectious Corneal Perforations. Cornea. 2022;41(9):1122-8. doi: 10.1097/ICO.0000000000002926. Epub 2021 Nov 22. PMID: 34812781; PMCID: PMC9365251.
41. Vanathi M, Sharma N, Titiyal JS, Tandon R, Vajpayee RB. Tectonic grafts for corneal thinning and perforations. Cornea. 2002;21(8):792-7. doi: 10.1097/00003226-200211000-00013. PMID: 12410039.
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