PMC10020790_01
Corneal perforation (3.5 mm) with iris presenting at the site with extensive corneo-limbo-scleral melt.
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F1
Slit-lamp biomicroscopy revealed large area of corneal perforation (3.53.5 mm) and extensive corneo-limbo-scleral necrosis [Figure 1].
Diagramatic presentation of retrocorneal sclera patch supported cyanoacrylate tissue adhesive application: (a) Corneal perforation (3.53.5 mm), corneal, limbal and sclera melt; (b) Punching of sclera patch (4.54.5 mm) using a skin bopsy punch; (c) Placing the thinned sclera patch behind the corneal perforation; (d) Application of minimum quantity of cyanoacrylate tissue adhesive at the margin of perforation on the sclera patch; (e) Injecting an air bubble in the anterior chamber; (f) At completion of surgical procedure, retrocorneal sclera patch (red arrow), cyanoacrlate tissue adhesive (blue arrow), and bandage contact lens (yellow arrow).
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F2
The corneal perforation measured 3.53.5 mm [Figure 2a]. The sclera was thinned to one-third of its thickness and a patch (4.54.5 mm) was punched out with skin biopsy punch [Figure 2b]. The scleral patch was placed on the iris, beneath the corneal perforation [Figure 2c]. The minimal amount of cyanoacrylate tissue adhesive (Amcrylate; Concord Drugs Ltd, Hayathnagar, Andhara Pradesh India) was applied on the retrocorneal sclera patch and margin of the corneal perforation [Figure 2d]. The cyanoacrylate tissue adhesive was allowed to polymerize [Figure 2e]. A bandage contact lens was placed [Figure 2f].
(a) Sealed corneal perforation 72 hr after surgery (scleral patch, CTA plug, and double layered AMG in place). (b) Corneal perforation sealed and corneo-limbo-scleral necrosis at healing stage at two-weeks' follow-up. (c) Healed corneal perforation (sclera patch in place) and pseudo-pterygium at 12 weeks' follow-up. (d) Healed corneal perforation (sclera patch in place) and pseudo-pterygium at 18 months' follow-up.
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F3
At 72 hr, the scleral patch, cyanoacrylate tissue adhesive plug, and double layered amniotic membrane graft were in place [Figure 3a]. At two weeks, corneal perforation was sealed and scleral necrosis started healing [Figure 3b]. He was advised excision of the pseudo-pterygium but was reluctant [Figure 3c]. During the 18 months' follow-up, patient did not develop any recurrence, the scleral patch remained in place and the patient had pseudo-pterygium [Figure 3d].