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

Background: 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. Methods: 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. Conclusions: 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.