Autocorneal Transplantation And Multimodal Surgical Management For End-Stage Infectious Keratitis In A Monophthalmic Patient With Severe Ocular Surface Disease, Secondary Glaucoma And Retinal Detachment

To report a challenging case of a 36-year-old monophthalmic patient with advanced juvenile glaucoma with severe ocular surface disease who developed a refractory infectious corneal ulcer leading to perforation, endophthalmitis and retinal detachement. The study highlights the role of platelet rich fibrin graft (PRF), antifungal intrastromal and intravitreal injections followed by autocorneal transplantation (autokeratoplasty) and subsequent vitreoretinal surgery as a ultimate "salvage" strategy when donor tissue is unavailable or high-risk.

Ibn Al Haythem Center

A 36-year-old monophthalmic male (left eye, LE), followed for juvenile glaucoma (IOP 36 mmHg), underwent trabeculectomy with adjunctive intrastromal Bevacizumab for corneal vascularization. One year postoperatively, he developed a severe infectious keratitis with hypopyon, refractory to intensive antibiotics, antifungal and dual PACK-Cross-Linking (CXL) sessions. Despite a PRF patch for perforation, a total cataract with pupillary seclusion and tractional retinal detachment (TRD) ensued. After several transplant refusals at other institutions, an autokeratoplasty (7.75mm trephine) was performed under general anesthesia. Postoperatively, the graft remained clear, allowing for a secondary 25G Pars Plana Vitrectomy (PPV) to manage the TRD. Surgical maneuvers included heavy liquid (PFCL) injection, release of peripapillary traction, and endolaser cerclage. A final procedure involved PFCL-Silicone oil (5700 cs) exchange with posterior capsulotomy. At the last follow-up (February 2026), the graft was stable, the retina was attached under silicone oil, and the patient showed significant visual improvement with controlled IOP.

Autokeratoplasty represents a critical salvage alternative for corneal perforation, particularly in monophthalmic patients when donor tissue is unavailable and the cornea of the blind contralateral eye remains viable for harvesting. This case demonstrates that a sequential multimodal approach—combining tectonic autografting and advanced vitreoretinal surgery—can successfully restore anatomy and useful vision in eyes previously considered lost.