Outcomes of corneal perforations secondary to microbial keratitis at a tertiary care center: A case series

The purpose is to characterize clinical outcomes and management strategies for corneal perforations secondary to microbial keratitis, and to identify potential risk factors for poor visual prognosis and trends in management.

This retrospective case series analyzed patients treated for corneal perforation secondary to documented microbial keratitis at a tertiary care center between July 2023 and July 2025. Patients with traumatic or autoimmune etiologies were excluded. Clinical data, including demographics, visual acuity, microbial culture results, time to perforation, and treatment modalities, were reviewed.

Of 23 identified corneal perforation cases, 5 were attributed to microbial keratitis. Pathogens included Pseudomonas aeruginosa, herpes simplex virus 1, and suspected fungal organisms; cultures were not obtained in all cases. Time to perforation ranged from immediate presentation to 8 weeks after symptom onset. Most patients (80%) underwent penetrating keratoplasty, while others were managed with corneal gluing, bandage contact lenses, or medical therapy alone. Final visual acuity varied significantly, with outcomes ranging from hand motion to 20/30. Worse visual outcomes were associated with central or large perforations and preexisting ocular comorbidities.

Corneal perforation due to microbial keratitis remains a severe, vision-threatening complication requiring timely and often surgical intervention. Delayed presentation and central ulceration were associated with poorer outcomes. Although limited by a small sample size and a retrospective design, this series highlights the variability in clinical course and visual recovery. Further prospective, multicenter studies are warranted to better define prognostic indicators and to guide standardized treatment algorithms for infectious corneal perforations.