“Tuck-in Tenon Patch Graft” Technique in Neurotrophic Keratitis: A Case Report

Abstract

Neurotrophic keratitis (NK) is a rare but serious corneal disorder caused by impaired corneal sensory innervation, leading to defective epithelial healing. Neurotrophic corneal ulcers can progress to deep stromal thinning or perforation, posing a significant risk to vision. Therapeutic options include tear substitutes, biological agents, and surgical interventions. Autologous Tenon’s patch graft has emerged as an effective alternative for managing refractory corneal ulcers, particularly when conventional therapies fail or donor tissue is unavailable. Its ability to provide stromal support and facilitate epithelial regeneration makes it especially valuable in resource-limited settings. We report a case treated with an autologous Tenon’s capsule graft using the “Tuck-in Tenon Patch Graft” technique, resulting in favorable anatomical and functional outcomes over a 60-day follow-up. The patient had diabetes with suboptimal glycemic control and prior use of non-steroidal anti-inflammatory drugs (NSAIDs). Preoperative visual acuity was 20/200 (1.0 LogMAR), improving to 20/100 (0.7 LogMAR) postoperatively, corresponding to a gain of three lines. Minimal stromal thickness increased from 210 µm preoperatively to 410 µm on day 30. Follow-up with anterior segment optical coherence tomography (AS-OCT) allowed precise, non-invasive monitoring of graft integration and stability. The Tuck-in Tenon Patch Graft is a simple, autologous, and effective technique for refractory neurotrophic corneal ulcers, particularly when access to amniotic membrane or donor corneal tissue is limited.