Corneal Perforations: Urgent Therapeutic Alternatives In The Absence Of Donor Tissue

To describe two surgical approaches for the urgent management of corneal perforations when donor corneal tissue is unavailable, aiming to restore globe integrity, maintain ocular stability, and prevent severe vision-threatening complications.

Tertiary referral center. Department of Ophthalmology in collaboration with Neurosurgery and Ocular Surface Unit.

Two consecutive cases of corneal perforation managed without donor tissue were reviewed.

Case 1: A 58-year-old male with central facial palsy after meningioma resection presented with a 2.2 × 2.5 mm paracentral corneal perforation. A 3×3 mm corneal trephination was performed, followed by placement of a manually fashioned scleral patch graft secured with 10-0 nylon sutures. A conjunctival flap was created to promote vascularization.

Case 2: A 91-year-old female with severe mucous membrane pemphigoid and phthisis in the fellow eye developed a 1×  mm central perforation. The defect was treated using layered fibrin tissue adhesive (Tisseel®) and amniotic membrane transplantation.

Anatomical closure and restoration of globe integrity were achieved in both cases.

In Case 1, the eye remained stable postoperatively, and penetrating keratoplasty is planned once the ocular surface and systemic condition are optimized.

In Case 2, a favorable outcome was observed with no recurrent leakage, good tissue integration, and a final best-corrected visual acuity of 0.3. Conservative management with close follow-up was maintained.

Corneal perforation is an ophthalmic emergency requiring immediate intervention to preserve globe integrity. When donor tissue is unavailable, scleral patch grafting with conjunctival coverage and the combination of fibrin adhesive with layered amniotic membrane transplantation are effective and reproducible alternatives. These techniques allow ocular stabilization and may delay or even avoid subsequent keratoplasty.