Case Report: Central Corneal Perforation Management Secondary to Neurotropic Keratopathy in the Absence of Tectonic Corneal Graft, Barcelona CP

To present the emergency management of a patient with corneal perforation secondary to post-herpetic neurotrophic keratopathy (NK) with fibrin glue and amniotic membrane transplantation (AMT) in the absence of a tectonic corneal graft. A 26-year-old male patient with a history of herpetic keratitis was admitted to our clinic with a finding of approximately 1 mm corneal central perforation in his right eye. The best corrected visual acuities of right and left eyes were 2.3 and 0 logMAR, respectively. Anterior segment examination revealed corneal edema, vascularization, shallow anterior chamber and central corneal perforation in the melting area. No pathology of the retina or vitreous was detected in B-scan ultrasonography. Anterior and posterior segment examination of left eye was normal. Conventional approaches including bandage contact lens failed to buffer the leak. Since human corneal donor tissue was not available, fibrin glue application from inside to outside along the perforation area combined with AMT was applied. Even after 2 weeks when the amnion was degraded, it was observed that the perforation area was stable without any additional intervention. NK is one of the challenging reasons of corneal perforation. Although tectonic keratoplasty is the main treatment modality owing to transparency and high tissue resistance in the central corneal perforation repair, alternative treatment methods are necessary due to difficulty of access to donor cornea. Tissue adhesives and AMT are conservative methods to buffer leak with easier access. Present case clarifies the importance of alternative management modalities of corneal perforation in the absence of tectonic graft. Considering that only 1 donor cornea is available to 70 needed around the world, corneal perforation repair with fibrin glue combined with AMT seems wise.