Severe Exposure Keratopathy Leading to Sterile Corneal Perforation Treated Successfully by Lamellar Corneal Patch Graft: A Case Report

Iman Ansari; Hamed Abbasi; Amir Mohammadzadeh; Kiana Hassanpour

doi:10.18502/crcp.v6i5.8379

Iman Ansari Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hamed Abbasi Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Amir Mohammadzadeh Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Kiana Hassanpour Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/crcp.v6i5.8379

Keywords: Exposure keratopathy; Corneal perforation; Corneal ulcer; Corneal perforation; Keratitis

Abstract

We reported a case of corneal perforation due to longstanding exposure keratopathy treated successfully with lamellar corneal patch graft, conjunctival flap, and lateral tarsorrhaphy. A 75-year-old male presented with ocular pain and decreased visual acuity in his right eye since 2 weeks ago. On external examination, lagophthalmos in the right eye was evident. Visual acuity was hand motion on slit-lamp examination. 2×3 mm perforated area in the right cornea accompanied by adjacent corneal melting and diffuse punctate epithelial keratopathy were observed. The anterior chamber was flat. Intraoperatively, a 7×2.5 mm-diameter corneal patch graft was fashioned manually; its thickness was reduced and placed over the perforated area, successfully sealed the cornea, a partial bipedicle conjunctival flap was also applied over the graft, and lateral tarsorrhaphy was performed. Four weeks after surgery, Corrected Distance Visual Acuity (CDVA) improved to Counting Finger (CF) 20 cm. The lamellar corneal patch graft was intact without a leak, and the conjunctival flap was partially removed retracted. Corneal perforation can occur in patients with severe exposure to keratopathy, and corneal patch graft is a good option when a sizeable corneal perforation (≥3 mm diameter) is not amenable to corneal gluing.