Surgical Approaches for the Management of Peripheral Ulcerative Keratitis With Corneal Perforation

Corneal perforation is a serious complication of peripheral ulcerative keratitis (PUK), which requires prompt control of the inflammation while restoring the integrity of the globe. This can often be challenging and may require 1 or a more surgical approaches.

We report the management of 3 cases of PUK with repeated perforations and failed attempts at corneal gluing. The first case had a combination of an acute hydrops with perforation in a patient with longstanding eczema and undiagnosed keratoconus. After multiple failed attempts at gluing, a partial thickness sclerocorneal banana graft was done to restore the globe integrity. The second case had bilateral Mooren ulcer with previous perforations sealed with gluing and presented with a large peripheral perforation, which required a peripheral circular full-thickness graft fashioned with a 9.5 and a 7.5 Baron punches. The third case had psoriasis-related PUK with peripheral melting and perforation, which settled after multilayer amniotic membrane transplantation. All cases required intense control of the inflammation in conjunction with the rheumatology team.

Management of PUK with perforation poses medical and surgical challenges, which can be employed as illustrated to obtain a successful outcome. Multilayer amniotic membrane transplantation can seal small perforations. Larger perforations may require fashioned banana-shaped grafts to restore the ocular integrity. Control of inflammation with systemic steroids and immunosuppression is paramount for a successful outcome.