Lyophilized Multilayer Amniotic Membrane Transplantation for Corneal Perforation: Globe-Salvage Outcomes and Morphology-Matched Surgical Configurations

The aim of this study was to report globe-salvage outcomes of lyophilized multilayer amniotic membrane transplantation (AMT) for corneal perforation and to propose a reporting framework that classifies the index lesion explicitly and measures the opening separately from the surrounding stroma.

Twenty-six consecutive eyes underwent lyophilized multilayer AMT by a single surgeon between 2013 and 2026. Each index lesion was retrospectively reaudited using standardized criteria as overt perforation, microperforation with microleakage, or impending perforation. Perforation diameter was recorded separately from the maximum stromal involvement diameter, defined as the contiguous stromal bed requiring reconstruction. Primary outcomes were ocular retention, nonphthisical globe preservation, and leak closure; analyses were descriptive.

The mean age was 73.2 years, and the median follow-up was 35.6 months (range, 1.7-127.0). Twenty-four eyes had an overt perforation, 1 a microperforation with microleakage, and 1 an impending perforation that opened intraoperatively; preoperative leakage was documented in 25 of 26 eyes. Among the 24 overt perforations, the median perforation diameter was 2.0 mm (range, 1.0-6.0), whereas the median stromal involvement diameter across all 26 eyes was 4.0 mm (range, 2.0-8.0). Ocular retention occurred in all 26 eyes (100%), leak closure in 25 (96.2%), and nonphthisical globe preservation in 24 (92.3%). Eighteen eyes (69.2%) achieved definitive repair, 6 (23.1%) served as bridge to penetrating keratoplasty, and 2 (7.7%) had a failure trajectory. None of the 10 fungal eyes failed.

Lyophilized multilayer AMT provided immediately available tectonic stabilization and globe salvage in high-risk corneal perforation. Reporting the index lesion category and the opening separately from the surrounding stroma may improve comparability across series.