Scleral Patch Graft In The Treatment Of Corneal Perforation - Case Report

The purpose of this case report is to present scleral patch graft as an alternative surgical technique in the management of corneal perforations, particularly in situations where urgent penetrating keratoplasty is not recommended or when donor tissue is unavailable. It aims to demonstrate its effectiveness in restoring globe integrity and preserving visual function, especially in peripheral perforations associated with inflammatory systemic disease.

Department of Ophthalmology, University Clinical Hospital in Białystok, Poland. A tertiary referral center providing comprehensive management of corneal diseases and complex anterior and posterior segment disorders, including corneal transplantation, cataract surgery, glaucoma surgery, vitreoretinal procedures, and oculoplastic surgery.

A 70-year-old male with a history of rheumatoid arthritis presented with bilateral corneal perforations and tissue prolapse in the right eye. On admission, best corrected visual acuity (BCVA) was 0.1 in the right eye and 0.3 in the left eye with ocular hypotony and choroidal detachment in both eyes.

Due to the patient's condition, a decision was made to proceed with surgical treatment. A allogenic scleral patch graft was performed over the perforation in the right eye, along with an additional amniotic membrane graft covering the lower half of the cornea. A lamellar amniotic membrane transplant was performed on the left eye.

Postoperative follow-up showed progressive stabilization of corneal condition. At the first follow-up visit, 10 days after surgery, the choroidal detachment has resolved and the intraocular pressure was within normal limits. Seven months after surgical treatment BCVA improved to 0.9 (right eye) and 0.6 (left eye). At the latest follow-up (17 months after the procedure), globe integrity was preserved with stable intraocular pressure. The patient's visual acuity has decreased to 0.2 (right eye) and 0.02 (left eye) due to the development of nuclear-cortical cataracts.

Scleral patch graft is an effective and readily available alternative to urgent penetrating keratoplasty in selected cases of corneal perforation. In peripheral perforations, it provides good long-term outcomes in terms of globe stability and satisfactory visual rehabilitation with a low risk of graft rejection. Importantly, this technique may reduce the need for intensive immunomodulatory therapy and prolonged topical steroid treatment typically required after corneal transplantation. It can also be combined with other techniques, such as amniotic membrane transplantation, and may serve as either a definitive treatment or a staged procedure prior to further surgical intervention.