We reported a case of CORNEAL PERFORATION due to longstanding exposure keratopathy treated successfully with lamellar CORNEAL patch graft, conjunctival flap, and lateral tarsorrhaphy. A 75-year-old male presented with ocular pain and decreased visual acuity in his right eye since 2 weeks ago. On external examination, lagophthalmos in the right eye was evident. Visual acuity was hand motion on slit-lamp examination. 2×3 mm perforated area in the right cornea accompanied by adjacent CORNEAL melting and diffuse punctate epithelial keratopathy were observed. The anterior chamber was flat. Intraoperatively, a 7×2. 5 mm-diameter CORNEAL patch graft was fashioned manually,its thickness was reduced and placed over the perforated area, successfully sealed the cornea, a partial bipedicle conjunctival flap was also applied over the graft, and lateral tarsorrhaphy was performed. Four weeks after surgery, Corrected Distance Visual Acuity (CDVA) improved to Counting Finger (CF) 20 cm. The lamellar CORNEAL patch graft was intact without a leak, and the conjunctival flap was partially removed retracted. CORNEAL PERFORATION can occur in patients with severe exposure to keratopathy, and CORNEAL patch graft is a good option when a sizeable CORNEAL PERFORATION (≥, 3 mm diameter) is not amenable to CORNEAL gluing.

Purpose: To report an unusual presentation of pellucid marginal degeneration (PMD).Case Report: A 57-year-old man with history of CORNEAL ectasia experienced acute hydrops and spontaneous CORNEAL PERFORATION in his right eye. Examination revealed PMD in both eyes. After initial treatment with cyanoacrylate adhesive and a bandage contact lens, therapeutic penetrating keratoplasty was undertaken in the right eye. Due to severity of the condition, the fellow eye was also scheduled for penetrating keratoplasty. Conclusion: Spontaneous CORNEAL hydrops and PERFORATION may occur in patients with CORNEAL ectasia due to PMD.

Purpose: To describe a case of chronic graft versus host disease (GVHD) leading to severe dry eye and recurrent CORNEAL PERFORATION in both eyes, its stepwise management and histopathological reports.Case Report: A 22-year-old woman with a history of thalassemia and subsequent high-dose chemotherapy followed by allogeneic bone marrow transplant (BMT) was referred to Farabi Eye Hospital. Despite aggressive medical and surgical intervention, CORNEAL vascularization in her right eye progressed and led to CORNEAL PERFORATION. Cyanoacrylate glue was applied to seal the PERFORATION, however it recurred. Multilayer amniotic membrane transplantation (AMT) was performed to seal the CORNEAL PERFORATION, which was effective for a short period. Subsequently, the CORNEAL PERFORATION recurred and penetrating keratoplasty was performed. After a few months deep vascularization and descemetocele occurred in the fellow left eye and the patient finally underwent therapeutic lamellar keratoplasty.Conclusion: Patients with GVHD are at risk of severe dry eye and subsequent CORNEAL vascularization.Recurrent and recalcitrant CORNEAL PERFORATION resistant to cyanoacrylate glue and multilayer AMT may occur. Proper systemic and ocular management alongside close collaboration with the hematologist is strongly recommended to control the condition.

Purpose: To report the anatomical and visual outcomes of double layered amniotic membrane transplantation (AMT) in eyes with advanced Pseudomonas keratitis leading to Descemetocele formation.Methods: This prospective interventional case series included 6 eyes of 6 female patients with pseudomonas keratitis caused by contact lens‑induced infection who underwent double layered AMT. Surgery was performed after the ulcers were found to be poorly responsive to antibiotics, and severe thinning or Descemetocele had developed. All patients underwent a complete examination pre‑ and postoperatively, as well as anterior segment optical coherence tomography (OCT) and pachymetry or Orbscan after the procedure.Results: Mean follow‑up period was 24 months. There was neither frank CORNEAL PERFORATION nor a need for emergent CORNEAL transplantation in any of the eyes. All patients had visual acuity of hand motions before the procedure which improved to 20/50 to 20/30 three months after surgery. No surgical or postoperative complication occurred in this series.Conclusion: Double layered AMT may result in acceptable anatomical outcomes in patients with advanced Pseudomonas keratitis with Descemetocele formation and can eliminate the need for emergent CORNEAL transplantation.

Purpose: To describe a new method of treatment of CORNEAL PERFORATION with extensive corneoscleral melt. Case Report: A 42-year-old man presented with moderate-sized (3. 5 mm) CORNEAL PERFORATION with extensive corneo-limbo-scleral ulceration following bare sclera excision of pterygium. No prior use of antimetabolites or postoperative beta radiation noted. We considered retroCORNEAL sclera patch supported cyanoacrylate application. The sclera was thinned to one-third thickness and a patch (4. 5×4. 5 mm) was punched. The sclera patch was placed on the iris, behind the CORNEAL PERFORATION, adequately covering it from inside. A minimal amount of adhesive was applied on the retroCORNEAL sclera patch and margin of CORNEAL PERFORATION. The ulcerating sclera was covered with double layered amniotic membrane. Topical antibiotic, steroid, and cycloplegic drops were instilled thrice daily. CORNEAL PERFORATION healed and no recurrence occurred during the 18 months’ follow-up. Conclusion: RetroCORNEAL scleral patch supported cyanoacrylate is effective for CORNEAL PERFORATION with corneo-scleral melt.