A Minimally Invasive Alternative To Keratoplasty In Corneal Perforation: Combined Subconjunctival Platelet Rich Plasma And Therapeutic Contact Lens

To report the successful non-surgical management of a corneal ulcer with perforation using combined subconjunctival platelet-rich plasma (PRP), topical PRP eye drops, and a therapeutic contact lens in a setting where keratoplasty was unavailable.

Tertiary ophthalmology department, AKFA Medline University Hospital, Tashkent, Uzbekistan.

A 61-year-old female presented with progressive pain and reduced vision in the right eye after failed pharmacotherapy. Examination revealed a paracentral corneal ulcer with stromal thinning and perforation, irregular pupil with posterior synechiae, and localized absence of anterior chamber. Advanced surgical options, including emergent keratoplasty and amniotic membrane transplantation, were unavailable, and the patient declined invasive surgery.

Treatment consisted of subconjunctival PRP injections (days 2, 4, and 6), topical PRP eye drops four times daily for one month, and placement of a silicone-hydrogel therapeutic contact lens. By day 4, ulcer size decreased by 40% with marked epithelialization. Pain improved by day 3. At one month, near-complete epithelial healing was achieved. Visual acuity improved from 0.1 to 0.4 at one year and remained stable at two-year follow-up. Anterior segment optical coherence tomography confirmed sustained corneal integrity without recurrence.

Combined subconjunctival and topical PRP with therapeutic contact lens may serve as a minimally invasive alternative or bridge therapy for corneal perforation when keratoplasty is unavailable or declined. This approach demonstrated rapid epithelialization, structural stabilization, and long-term visual improvement in a resource-limited setting.