Stepwise Surgical Management Of Corneal Perforations: A Case Series Of Amniotic Membrane Grafting And Tectonic Lamellar Keratoplasty Previous To Penetrating Keratoplasty
Published 2025 - 43rd Congress of the ESCRS
Reference: PO177 | Type: Case Report | DOI: 10.82333/v0y5-1y11
Authors: Clara Pons Talaya* 1 , Rubén Delgado Weingartshofer 2 , Andrea Pastor Asensio 1 , Claudia Andino Angulo 1 , Miriam Barbany Rodríguez 3
1Centro de Oftalmología Barraquer,Barcelona,Spain, 2Cornea,Centro de Oftalmología Barraquer,Barcelona,Spain, 3Cornea,Centro de Oftalmología Barraquer,Barcelona,Spain;Cornea,Hospital MútuaTerrassa,Terrassa,Spain
Purpose
To describe two cases of a stepwise surgical approach for managing corneal perforation in patients with different underlying conditions, highlighting the use of amniotic membrane grafting, lamellar tectonic keratoplasty, and subsequent interventions to restore ocular integrity and function.
Setting
The emergency department and cornea clinic at our institution.
Report of case
Case 1: A 59-year-old male presented to the cornea clinic with a corneal perforation in his left eye due to foreign body trauma. Initial management included Tennon and amniotic membrane grafting and anterior chamber reformation. However, persistent atalamia and suture dehiscence led to urgent lamellar tectonic keratoplasty, successfully restoring ocular structure. Three months later, a standard penetrating keratoplasty with cataract extraction and intraocular lens implantation was performed, achieving visual rehabilitation.
Case 2: A 73-year-old male with pseudophakia, glaucoma, undergoing immunotherapy for cutaneous melanoma presented to our emergency department with a corneal perforation and iris incarceration in his right eye (RE) secondary to bilateral peripheral ulcerative keratitis (PUK). Amniotic membrane grafting with iris repositioning was performed, but a positive Seidel test one week postoperatively necessitated urgent tectonic lamellar keratoplasty, restoring anterior chamber integrity. One week later, the patient developed herpetic keratitis, which responded to topical and systemic treatment. The patient remains stable with ongoing therapeutic adjustments.
Conclusion/Take home message
A sequential surgical approach combining amniotic membrane grafting, tectonic lamellar keratoplasty, and tailored postoperative management can effectively address complex corneal perforations. Close follow-up and an adaptive treatment strategy are essential to preserving ocular integrity and optimizing visual outcomes, particularly in patients with pre-existing conditions or immunosuppressive therapy.