Utility of peripheral lamelar corneal graft in PUK with corneal perforation treatment

Purpose Peripheral ulcerative keratitis (PUK) is a destructive inflammation of the limbal corneal stroma with oval morphology. It is characterized by a sectorial affection with corneal thinning, usually associated with an epithelial defect, cell infiltration and progressive lysis of the stroma, which can progress to corneal perforation. We present a case of a 88 years old woman who came to our hospital with epifora and foreign body sensation in the left eye. It was observed perforated marginal corneal ulceration in inferonasal quadrant with iris incarceration. She was treated with therapeutic contact lens and topical antibiotics and was programmed for surgery. In order to maintain the corneal integrity and due to the dimensions of the perforation, we decided to employ a lamellar corneal grafting because the use of tissue adhesives or amniotic membrane coating would be insufficient. This prevents the elimination of healthy cornea and keep better the anatomy. In the same surgery the graft was covered with amniotic membrane patch securing it with biological glue and coated with therapeutic contact lens. Methods The lamellar corneal grafting was obtained by manually cutting one of the corneoscleral edges of a donor cornea, in which the central corneal button was drilled and used for another patient in a penetrating keratoplasty the same day of surgery. Results The postoperative time coursed with no complications and showed good integration of corneal graft, through images of the anterior segment and AS‐OCT. Conclusions Lamellar corneal graft seems to be a good treatment option for maintaining the tectonic integrity in perforated patients due to peripheral ulcerative keratitis.