A Rare Case of Simultaneous Bilateral Corneal Perforations in Chronic Ocular Graft-Versus-Host Disease

To describe the clinical course and management of a patient with bilateral, simultaneous corneal perforations associated with chronic graft-versus-host disease (GVHD) and subsequent phacolytic glaucoma, highlighting the role of cyanoacrylate glue, amniotic membrane transplantation, and anterior segment optical coherence tomography (AS-OCT) in disease monitoring.

Case report and literature review.

A 58-year-old male with chronic ocular and skin GVHD presented with bilateral corneal perforations, confirmed via slit-lamp examination and AS-OCT. Initial visual acuity was light perception in both eyes. Immediate surgical management involved cyanoacrylate glue application and amniotic membrane transplantation, followed by medical therapy with systemic corticosteroids, topical antibiotics, autologous serum tears, and bandage contact lenses. Postoperatively, the patient's ocular surface stabilized, with corneal healing confirmed on AS-OCT. The patient later developed phacolytic glaucoma due to intumescent white cataracts, requiring endoillumination-assisted phacoemulsification. At 2.5 years, visual acuity had improved to 20/60 OD and 20/125 OS, with normal intraocular pressures and controlled ocular GVHD.

While corneal perforation is a rare but sight-threatening complication of chronic ocular GVHD, simultaneous bilateral corneal perforations are exceptionally uncommon, with only one previously documented case in the literature. Cyanoacrylate glue and amniotic membrane transplantation provided effective stabilization, while AS-OCT facilitated precise monitoring of corneal healing. This case underscores the importance of prompt surgical intervention, interdisciplinary management, and vigilant long-term monitoring. Early identification and management of secondary complications, including phacolytic glaucoma, contributed to visual rehabilitation.