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

Purpose: 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. Patients and Methods: 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. Results: 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. Conclusion: 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. Keywords: corneal perforation, ocular surface disease, amniotic membrane, sutureless grafting, dry eye, amniotic membrane transplantation, sutureless technique, autoimmune keratopathy, anterior segment optical coherence tomography