Sutureless Amniotic Membrane Grafting in the Management of Corneal Perforations Associated with Severe Ocular Surface...

To assess the safety and clinical outcomes of sutureless amniotic membrane (AM) transplantation in patients with small corneal perforations associated with severe ocular surface disease.

This prospective observational study included 50 eyes of 50 patients with autoimmune or inflammatory ocular surface disease presenting with corneal perforations ≤3 mm. Under topical anesthesia, a double-layer AM was applied without sutures: one layer as a graft directly over the perforation and a second as a patch. A therapeutic contact lens and temporary eyelid closure were used; no topical medications were prescribed, while oral doxycycline (100 mg twice daily) was given for 15 days. Patients were examined at 1 week, 2 weeks, 1 month, 3 months, and 6 months. Primary outcomes were anatomical closure and corneal thinnest point (swept-source OCT). Secondary outcomes included complications and need for further surgery.

Complete anatomical closure was achieved in all cases (100%), with a mean healing time of 14.2 ± 3.6 days (range 9-21). Corneal thinnest point increased significantly from 215 ± 38 µm at baseline to 402 ± 39 µm at 6 months (p = 0.000031, repeated-measures ANOVA). No cases of AM displacement, secondary infection, intraocular complications, or re-intervention were observed. The procedure was well tolerated in all patients.

Sutureless AM transplantation is a safe, minimally invasive, and effective option for managing ≤3 mm non-infectious corneal perforations in severe ocular surface disease. It enables rapid anatomical restoration, avoids suture-related inflammation, and may be particularly advantageous in fragile or immunocompromised patients.