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Corneal perforation is a potentially devastating complication that can result from numerous conditions that precipitate corneal melting. It is associated with significant morbidity and prompt intervention is necessary to prevent further complications. Causes include microbial keratitis, ocular surface disease, and autoimmune disorders and trauma. Various management options have been described in the literature to facilitate visual rehabilitation.
These procedures range from temporizing measures such as corneal gluing to corneal transplantation, with decision making, guided by the location, size, and underlying etiology of the perforation.
Tissue adhesives may be used to manage small corneal perforations. Currently, nonbiologic (cyanoacrylate) and biologic (fibrin glue) adhesives are available.
Large corneal perforations are not amenable to the abovementioned treatment modalities and often require a tectonic keratoplasty. Tectonic corneal transplants restore globe integrity by filling corneal stromal defects. Surgical techniques such as full-thickness keratoplasty, lamellar keratoplasty, and corneal patch grafts have been described, and are chosen depending on the size, depth, location, and cause of perforation. |
