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Purpose: To report 2 cases of corneal perforation associated with a persistent epithelial defect (PED), which were treated with eye drops containing the fibronectin-derived peptide PHSRN (Pro-His-Ser-Arg-Asn)., Methods: A 67-year-old man and a 58-year-old man presented with corneal perforation associated with a PED caused by lagophthalmos. PHSRN eye drops were administered 4 times a day to both patients., Results: Both patients experienced healing of the epithelial defect and closure of corneal perforation within 3 or 4 days after the onset of PHSRN treatment. Anterior segment optical coherence tomography also revealed recovery of corneal stromal thickness at the lesion site., Conclusions: PHSRN eye drops were effective for the treatment of corneal perforation due to the PED, with rapid reepithelialization being followed by full restoration of stromal thickness.

Objective: To describe a novel surgical technique for the treatment of large corneal perforations by using acellular multilayer of corneal stromal lenticules., Methods: Prospective study. The acellular tissue used for the repair was harvested from myopic patients during the femtosecond laser (FS) refractive surgery. Informed consent, blood test and donor eligibility were obtained in each case. Three or four layers of lenticules were stacked up and stored at -80°C in pure sterile glycerin. The diameter is 6.0 to 6.5 mm and central thickness was 300 to 400 µm. If the diameter of the corneal ulcer perforation was larger than 3 mm and corneal grafts were not available, we used this kind of patches to seal the perforations. It was a retrospective case series study. Five cases of corneal ulcer perforation were enrolled in this study. One was neuropathic keratitis, one was atopic keratoconjunctivitis, and the other three were fungal keratitis. Acellular multilayer of stromal lenticules were used in these cases for emergent therapy., Results: The sealing of the perforation and the re-establishment of the anterior chamber were achieved successfully in all the cases. For the pericentral perforations, visual recovery was achieved. And efficient palliative management was done for the central perforations., Conclusions: The reported technique seems to represent a good alternative emergency procedure for the management of large corneal perforations. It is a very useful method for Chinese hospitals where the shortage of cornea donors is a very serious problem and the amount of FS surgeries are increasing.

Corneal emergencies can be due to a number of different causes and may be vision threatening if left untreated. In an attempt to stabilize the cornea, it is of benefit to place an Elizabethan collar on the patient to prevent further corneal damage. This article discusses the diagnosis, prognosis, and management of corneal emergencies in dogs and cats., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background and Objectives: Accessory lacrimal gland ductal cyst is a rare clinical entity that has been reported after trauma, infection, or conjunctival inflammation. Trachoma has been postulated as an etiologic factor for this dacryops in Saudis. We studied the prevalence, demographics, clinicopathological features and surgical approach for these lesions., Design and Setting: Retrospective study of 23 consecutive ductal cysts diagnosed clinically and proved histopathologically at King Khaled Eye Specialist Hospital (KKESH) over 23 years (1991-2014)., Patients and Methods: Data on patient demographics, clinical features, surgery, and outcome were collected by chart review. The histopathologic slides were reviewed by a single pathologist., Results: Of 23 cases of accessory lacrimal gland ductal cysts confirmed histopathologically, 14 were males and 9 females with a median age of 38.8 years. Cysts were located in the upper eyelid in 73.9%. The commonest presentation was a painless eyelid mass in 91.3%. Excision by conjunctival incision was performed in 14 and intra-operative perforation occurred in 9. Trachomatous scarring was evident in 39.1% but did not have significance in relation to this rupture. No recurrences have been observed with a mean follow up of 34.6 months., Conclusion: The approximate prevalence of accessory lacrimal gland dacryops in the Saudi population is 1/6800. Trachoma does not seem to be a major predisposing factor. They are more frequent in males. Their histopathological appearance is identical regardless of origin. The presence of conjunctival scarring, dacryops size, and the surgical incision type did not seem to have significant correlation with the iatrogenic rupture of the cyst. We recommend careful dissection for complete cyst excision through conjunctival approach with no expected recurrence.

We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents.

Objective: To report the histopathologic findings of 3 corneal buttons incised from 2 patients during penetrating keratoplasty (PKP) because of corneal perforation due to corneal siderosis., Methods: Three eyes of 2 patients had accidental trauma to the corneas caused by iron fragments; the injuries were initially treated conservatively with antibiotics and therapeutic soft contact lenses. However, the corneal stroma melted and perforated, necessitating corneal transplantation. The corneal buttons removed during PKP were examined histopathologically, and the findings were compared with the slit-lamp biomicroscopic and anterior segment optical coherence tomographic (AS-OCT) findings., Results: Slit-lamp examinations showed that the corneal epithelium was hyperplasic around the area of perforation in 2 eyes 1 month after the injury. Wide areas of the stroma had melted, and the corneas were perforated. The corneal epithelium was atrophic in the perforated corneas 4 months after injury. Histopathologically, the corneal stroma and Descemet's membrane were stained by Prussian blue, suggesting that the ferric ions had penetrated deeper than expected by the slit-lamp examinations. The areas of Prussian blue staining corresponded well with the areas altered in the AS-OCT images., Conclusions: Ferric ions penetrate much deeper into the cornea than estimated by slit-lamp biomicroscopy. The ferric ions can induce stromal melting that can lead to corneal perforation. We conclude that (i) the ferric ion-infiltrated areas can be estimated in the AS-OCT images and (ii) extensive corneal abrasion should be performed to prevent corneal melting and perforation., (Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the efficacy of corneal cross-linking (CXL) as an adjuvant to appropriate antifungal therapy in nonresolving deep stromal fungal keratitis., Design: Randomized clinical trial., Methods: Eyes with culture-positive deep stromal fungal keratitis not responding to appropriate medical therapy for a period of 2 weeks were randomized to receive either adjuvant CXL or no additional treatment. Antifungal medical therapy was continued in both groups. The prespecified primary outcome was treatment failure at 6 weeks after enrollment, defined as perforation and/or increase in ulcer size by ≥2 mm., Results: The trial was stopped before full enrollment because of a marked difference in the rate of perforation between the 2 groups. Of the 13 cases enrolled in the study, 6 were randomized to the CXL group and 7 to the non-CXL group. Five eyes in the CXL group and 3 eyes in the non-CXL group experienced treatment failure by 6 weeks (P = .56). In a secondary analysis, the CXL group experienced more perforations than the non-CXL group (4 vs 0, respectively; P = .02)., Conclusion: CXL used as adjuvant therapy for recalcitrant deep stromal fungal keratitis did not improve outcomes., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Peripheral corneal melting syndrome is a rare immune condition characterized by marginal corneal thinning and sometimes perforation. It is associated with rheumatic and non-rheumatic diseases. Few cases of peripheral corneal melting have been reported in patients with psoriasis. The pathogenesis is not fully understood but metalloproteinases may play a pathogenic role. Anti-TNF therapy has shown to decrease skin and serum metalloproteinases levels in psoriasis. We report a 61-year-old man with peripheral corneal melting syndrome associated with psoriatic arthritis who received Adalimumab to control skin and ocular inflammation. To our knowledge, this is the first case report of peripheral corneal melting syndrome in psoriatic arthritis treated with Adalimumab showing resolution of skin lesions and complete healing of corneal perforation in three months., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.)

Purpose: To describe spontaneous corneal perforations in patients with atopic keratoconjunctivitis., Methods: Records of patients with atopic keratoconjunctivitis and spontaneous corneal perforation seen by the authors were reviewed. A literature search of corneal complications in atopic keratoconjunctivitis and predisposing factors for spontaneous corneal perforations in corneal ectasias was undertaken., Results: Three patients with seven incidents of corneal perforation were identified and presented. Corneal thinning and keratoconus are observed at a higher rate in patients with atopic keratoconjunctivitis, and severe ocular allergy has been reported as a risk factor for corneal hydrops., Conclusions: Atopic keratoconjunctivitis appears to be a risk factor for spontaneous sterile corneal perforation. Corneal thinning and keratoconus in addition to inflammatory changes of the cornea in these patients probably predispose to the corneal melt in these perforations. A close observation of the fellow eye of affected patients is important and systemic immunosuppressive therapy should be considered., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To describe the ocular complications at the end of serious drug eruptions such as Lyell syndrome or toxic epidemic necrolysis (TEN) syndrome, Stevens-Johnson syndrome (SJS), and SJS/TEN overlap syndrome; to analyze their relationship using disease severity scores., Patients and Methods: A retrospective study carried out in the dermatology department in collaboration with the ophthalmopathy department in a series of 81 dossiers collated over a 10-year period. The severity of ophthalmological involvement was evaluated using the Foster score, and the drug eruption score was assessed using the Bastuji-Garin classification and the SCORTEN prognostic score., Results: The average patient age was 36 years; the clinical forms seen were Lyell's syndrome in 57.8 % of cases, Stevens-Johnson syndrome in 32.8 % and overlap syndrome in 9.4 % of cases. According to the Foster classification, 34 % of patients were in stage I, 43 % in stage II, and 22 % in stage III. Stage I was seen in 50 % of cases presenting with overlap syndrome and in 42 % of patients with Stevens-Johnson, whereas stage III accompanied Lyell's syndrome in 27 % of cases, followed by SJS/TEN overlap syndrome in 16.6 % of cases. Photophobia persisted in 36 patients, and there were 17 cases of decreased visual acuity and 13 cases of eyelid malposition. Dry eye syndrome was noted in 39 cases and corneal perforation in 3 cases., Discussion: The ocular manifestations of drug eruptions are daunting. It was suggested that ocular involvement is more serious when the peeled skin surface is extensive., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: The treatment of non-traumatic perforations of the cornea is a real challenge for the choice of surgical technique as well as for management of the causal pathology. The goal of our study is to determine the anatomical and functional results of the management of non-traumatic perforation of the cornea in the absence of ready access to a corneal graft., Materials and Methods: This is a retrospective, non-comparative monocentric study of 23 consecutive cases diagnosed and treated between January 2011 and January 2013. We included 23 eyes with non-traumatic corneal perforation. Various surgical techniques were used depending on the size and location of the corneal perforation., Results: The predominant etiology of the corneal perforations in our series was corneal abscess, found in 30.4% of cases (7 eyes). A conjunctival flap was performed in 43.5% of cases (10 eyes) followed by tarsorrhaphy in 21.7% of cases (5 eyes), autologous corneal patch in 17.4% of cases (4 eyes), amniotic membrane in 13% of cases (3 eyes) and finally cyanoacrylate glue in one case. Mean follow-up was 12.4 ± 2.1 months. Anatomical closure of the corneal perforation was achieved in 91.3% of cases (21 eyes), while the final visual acuity was not improved due to secondary opacities., Discussion: The choice of surgical technique depends on the size of the corneal perforation, its location, its etiology and the resources available for emergencies. When amniotic membrane and corneal donor tissue are unavailable, conjunctival flap is an easy and effective technique, which is a good alternative to close corneal perforations less than 3mm. It improves ocular surface quality and prepares the eye for later penetrating keratoplasty., Conclusion: Conjunctival flap is a good technique that is still relevant today, especially in the absence of corneal donor tissue or amniotic membrane. The anatomical success rate is very satisfactory, but sometimes several interventions are needed to improve the visual prognosis., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Purpose: To report two cases of microbial keratitis with subsequent corneal perforation immediately following corneal collagen crosslinking (CXL)., Methods: Retrospective case note review., Results: First case was a 19 year old female presented with staphylococcal corneal abscess 3 days post CXL procedure. Corneal perforation occurred during hospital admission and was successfully treated with corneal gluing. Microbial keratitis eventually resolved, with both topical and systemic antibiotics therapy, resulting in a vascularized corneal scar. Second case was an 18 year old male whom developed Methicillin Resistant Staphylococcus aureus (MRSA) corneal abscess 5 days after CXL procedure for progressive keratoconus. Corneal perforation occurred 48 h after presentation and patient underwent uneventful corneal gluing. Although infective keratitis was successfully treated with topical therapy, patient had visual outcome of count fingers due to scarring., Conclusions: CXL has been widely used in the treatment of corneal ectatic conditions and complications, such as infective keratitis, are uncommon post procedure. We present two cases of severe microbial keratitis with subsequent corneal perforation within 7 days of CXL. The exact mechanism for the accelerated keratolysis process is unclear. Nonetheless, patients should be well-informed of such potentially devastating complication., (Copyright © 2014. Published by Elsevier Ltd.)

A young female presented with blurred vision in the left eye after she rubbed her eye. On examination of both eyes, she had 360° thinning adjacent to the limbus, lipid deposition and superficial vascularization with a perforation in the left eye. The patient was diagnosed with bilateral Terrien's marginal degeneration (TMD) with perforation. Corneal topography of the right eye revealed high oblique astigmatism confirming the diagnosis. A peripheral patch graft was performed for the left eye. At 18 months postoperatively, the best-corrected visual acuity was 20/20 in both eyes. The graft was clear. Topography of right eye was stable, and the left eye had oblique astigmatism. Bilateral advanced TMD in a young patient presenting with corneal perforation following trivial trauma is extremely uncommon. Patch graft may be an option for restoring the globe integrity in such cases. Regular follow-up is necessary as the condition progresses slowly.

Introduction: Retinal hemangioblastoma is one of the most common tumors in von Hippel-Lindau disease. In addition to the classical pathological characteristics of von Hippel-Lindau disease, we report, for what we believe to be the first time, a severe and rare ocular complication characterized by neovascularization in the cornea and iris., Case Presentation: A 41-year-old white man with a long history of retinal hemangioblastoma presented with neovascularization of his iris and cornea as well as corneal perforation. His right eye was blind and painful, leading to a decision of enucleation. On microscopy, the enucleated eye showed neovascularization of the cornea and iris. The cornea was perforated with an expulsive hemorrhage and extruding intraocular contents, including the retina. A large retinal hemangioblastoma was located at the posterior pole adjacent to the optic nerve head. The tumor was mainly composed of large cells with foamy cytoplasm. Bone formation was also present., Conclusion: Our pathology findings were consistent with previously described features of retinal hemangioblastoma. The present case is unusual because of the co-existing neovascularization in the iris and cornea, which may have led to corneal perforation and vision loss.

To date, there has been only one published report on the infectious sclerokeratitis caused by Metarhizium anisopliae, which is an entomopathogenic fungus. Regarding corneal infection, three reports have been published to date. Although the prognoses of the corneal infections are favourable, prognosis when scleral infection is involved is very poor. A 76-year-old patient presented with foreign body sensation in the left eye. Microscopic examination with Fungi Flora Y staining of the corneal scraping revealed fungal infection. The conjunctiva was melted by the infection over a wide area. Although intensive medications were administered, an emergency surgery was necessary because scleral thinning, corneal perforation and lens prolapse occurred. The fungal isolate was identified as M. anisopliae by sequencing the internal transcribed spacer region. Herein, we report the second known case worldwide of M. anisopliae sclerokeratitis, and we review the literature related to the ocular infections., (© 2015 Blackwell Verlag GmbH.)

We describe the presentation and subsequent management of a case of keratitis caused by Neisseria gonorrhoeae. A thirty-nine year old gentleman presented with a purulent ocular discharge. Corneal melt with corneal perforation occurred. Neisseria gonorrhoeae was cultured. Systemic and topical antibiotics were given. Deep lamellar keratoplasty was performed for corneal perforation. At three months post treatment no recurrence of infection was noted. The possibility of Neisseria gonorrhoeaea keratitis should always be considered in patients with a purulent ocular discharge even if the case history is not immediately suggestive of the same. Severe gonococcal keratitis may be unilateral. Deep lamellar keratoplasty can be considered as a therapeutic option in patients with severe gonococcal keratitis.

Purpose: To report a case of corneal hydrops with perforation in a patient with ectasia after undergoing laser in situ keratomileusis (LASIK)., Methods: An observational study with clinical, optical coherence tomographic, and histopathologic findings., Results: A 41-year-old woman had an acute onset of blurry vision, pain, photophobia, tearing, and foreign body sensation in the right eye 10 years after undergoing unilateral LASIK in Jordan. According to her, the surgeon elected not to operate on the left eye because of a "corneal abnormality." On slit-lamp examination, a tear in Descemet membrane with a stromal cleft extending to the overlying LASIK flap interface was noted. The flap was partially dehisced by a diffuse channel of aqueous humor draining from the cleft and streaming out the temporal flap edge. When leakage failed to stop after 2 weeks of treatment with a bandage contact lens, the patient underwent penetrating keratoplasty. Histopathological examination of the host button showed a fluid-filled cleft connecting the flap interface. Slit-lamp examination and corneal topography of the contralateral left eye were consistent with keratoconus., Conclusions: Corneal hydrops with perforation in the setting of post-LASIK ectasia is extremely rare and may be associated with flap dehiscence requiring penetrating keratoplasty.

Background: Corneal perforation in severe Stevens-Johnson syndrome (SJS) presenting great therapeutic difficulties, the imperative corneal transplantation always result in graft failure and repeated recurrence of perforation. The aim of this study was to evaluate the effectiveness of a modified small tectonic keratoplasty (MSTK) with minimal corneal graft in the management of refractory corneal perforation in severe SJS., Methods: Refractory corneal perforations in ten patients (10 eyes) with severe SJS were mended with a minimal corneal patch graft, under the guidance of anterior chamber optical coherence tomography, combined with conjunctival flap covering. The outcome measures included healing of the corneal perforation, survival of the corneal graft and conjunctival flap, relevant complications, and improvement in visual acuity., Results: Corneal perforation healed, and global integrity was achieved in all eyes. No immune rejection or graft melting was detected. Retraction of conjunctival flap occurred in one eye, which was treated with additional procedure. Visual acuity improved in six eyes (60%), unchanged in three eyes (30%) and declined in one eye (10%)., Conclusions: The MSTK combined with conjunctival flap covering seems to be effective for refractory corneal perforation in severe SJS.

We present an 8-month-old female patient with bilateral spontaneous corneal perforation and lamellar ichthyosis. On examination, the skin of the body and face of the patient was completely dry and scaly. Cicatricial ectropion and descemetocele with small perforations were seen. Double-layered amniotic membrane transplantation on the cornea with eyelid construction was performed on both eyes. At the 6-month follow-up, lower eyelid minimal ectropion formation and inferior corneal leukoma were seen bilaterally. In ichthyosis patients, the cornea should be monitored closely due to the risk of severe visual loss and corneal perforation.

Unlabelled: We present a case of corneal perforation secondary to an intrastromal astigmatic keratotomy performed with an optical coherence tomography-guided femtosecond laser. The keratotomy was concomitant with cataract surgery and resulted in a flat anterior chamber prior to the start of lens extraction. Interrupted nylon sutures were placed to seal the keratotomy prior to phacoemulsification. Escape of cavitation bubbles into the anterior chamber or the liquid interface can alert the surgeon to the possibility of unintended perforation of the endothelium or the epithelium, respectively., Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Acute corneal hydrops (ACH) and perforation in corneal thinning diseases are the consequences of exposure to distending intraocular pressure (IOP) forces that are in excess of corneal resistance to them. Apart from thinning, resistance to these forces may be reduced by disease-related tissue changes, such as corneal scarring, which could lower resistance to IOP. Eye rubbing trauma has sometimes been found to be associated with ACH and perforation. This association is not surprising given that the combination of rubbing-related mechanical tissue trauma and the associated increased distending stress of higher IOP seem likely to increase the risk of complications. Many cases of ACH and perforation are described as spontaneous, but this classification may be the consequence of not considering the multiple potential mechanisms for IOP elevation such as coughing, sneezing, nose blowing, and sneeze suppression in addition to those related to eye rubbing/wiping/massaging/touching as well as changes in body orientation, strenuous exercise, and wearing swimming goggles for example. Classification of ACH or perforation as spontaneous may lead patients to assume that nothing can be done to avoid these complications. Patients with corneal thinning diseases who are counseled regarding the potential precipitating mechanisms for IOP elevation will have the opportunity of reducing exposure to them and the risk of the associated complications. In addition, when ACH or perforation occur, faster resolution of edema and wound healing may depend on reducing potentially exacerbating exposures to mechanisms for IOP elevation.

Clinical Case: We report 2 cases of patients affected by non-infectious corneal macroperforations treated with TachoSil(®) and Tutopach(®), which closed the defect., Discussion: This procedure is an excellent choice for the emergency treatment of corneal perforation, especially in those centres that have no other therapeutic options, preserving the eye and visual acuity., (Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.)

A 24-year-old man presented with pain, sticky discharge and loss of vision in the right eye. He has had typical skin manifestations of porphyria cutanea tarda (PCT) since 6 years and ophthalmological symptom for 6 weeks. On ophthalmological examination, visual acuity was light perception in the right eye and 6/12 in the left. There were bilateral, symmetrical temporal scleromalacia along with temporal corneal melting in both eyes and perforation in the right eye. Ultrasonography B-scan (USG B-scan) revealed a retinal detachment in the right eye. Artificial tear instillation was started every hour along with topical antibiotic coverage in both eyes. Additionally, ultraviolet protective sunglasses and hat for photo-protection was advised. The vision in the right eye improved to 5/60 along with subsidence of retinal detachment on repeat USG B-scan after 3 weeks.

A 61-year-old woman with long-standing rheumatoid arthritis presented with the sensation of a foreign body in her right eye; she reported no symptoms in her left eye. The patient had systemic symptoms associated with her rheumatoid arthritis and was taking naproxen.

An 89-year-old patient presented in an emergency situation with a perforated corneal ulcer of neurotrophic genesis. An operative treatment with a Tutopatch® was performed. In the course of treatment a reorganization of the Tutopatch® into corneal tissue resulted and a subsequent satisfactory defect covering with maintenance of visual acuity. Tutopatch® represents a good alternative for covering perforated corneal ulcers.

Purposes: To describe a new technique of scleral tissue augmented cyanoacrylate tissue adhesive (CTA) application and to evaluate its efficacy in noninfectious corneal perforations that measure between 3.5 and 4.5 mm., Methods: Retrospective noncomparative case series included 16 consecutive patients diagnosed with moderate-sized corneal perforations measuring 3.5 to 4.5 mm who were treated with scleral patch graft augmented glue application. A partial-thickness scleral patch equal to the size of corneal perforation was placed in the corneal perforation site. After the area was sufficiently dried, CTA was applied on the interface of the host cornea and scleral patch. The ability of the scleral patch graft with CTA to seal the perforation and allow complete wound healing was considered a successful outcome., Results: The corneal perforation healed in 14 eyes (87.5%), with a mean of 5.65 weeks (range, 5-9 weeks). One eye (6.25%) developed microperforation that required additional CTA to seal the wound. Three eyes (18.75%) required reapplication of the scleral patch graft and CTA. The 2 eyes (12.50%) that failed scleral patch with CTA were successfully treated with tectonic penetrating keratoplasties. In all 5 eyes (100%), the corneal perforations as a result of Mooren ulcer healed in a mean 5.80 weeks (range, 5-7 weeks). One patient developed retinal detachment with proliferative vitreoretinopathy and cataract after trauma., Conclusions: Scleral patch graft augmented CTA technique is a successful alternative treatment method to emergent penetrating keratoplasty for corneal perforations that measure 3.5 to 4.5 mm.

Purpose: To report a novel technique for repairing corneal perforations in 5 eyes of 3 patients with pellucid marginal degeneration (PMD). Four cases were successfully repaired with corneal sutures and 1 case required a penetrating keratoplasty., Methods: Retrospective case series of corneal perforation repairs in the setting of PMD., Results: Four perforations were managed successfully with primary closure resulting in acceptable best spectacle-corrected visual acuity and stable corneal topography. One corneal perforation required a penetrating keratoplasty after unsuccessful suture repair., Conclusions: Primary repair of corneal perforations in cases of PMD can be achieved with corneal suturing alone. This technique may achieve a satisfactory visual and topographic outcome with minimal complications.

Purpose: To evaluate the use of a collagenous patch derived from bovine pericardium (Tutopatch) associated to a clot of autologous eye platelet-rich plasma (E-PRP) as a surgical alternative for the closure of perforated corneal ulcers., Methods: A total of 6 patients with perforated corneal ulcers were treated. The Tutopatch was fixed to the conjunctiva with nylon stitches and then the E-PRP clot was placed on the corneal surface, underneath the patch. At the end of the procedure, a partial temporal tarsorrhaphy was done. Patients were observed daily for the following 10 days., Results: In all cases, the corneal perforation was sealed. The bovine pericardium patch was present over the corneal surface until the tarsorrhaphy was opened. No evidence of infection or inflammation was detected. Digital tonometry confirmed acceptable ocular pressure in all cases from day 2 after the surgery. No patients reported pain, discomfort, or any subjective symptoms, and no complications were observed. The tarsorrhaphy was opened 2 to 3 weeks after the surgery, and the ocular surface was inspected without signs of leakage. The patients were followed up for 3 months with no evidence of relapses or perforations in 5 of them., Conclusion: The combined use of Tutopatch and E-PRP clot was found to be a safe and effective surgical technique for the closure of perforated corneal ulcers. This technique could be an alternative for the urgent management of perforated corneal ulcers although additional studies are needed to determine the technique's overall effectiveness.

Collagen crosslinking (CXL) has been proposed as a treatment for infectious keratitis. Given the insurgence of antibiotic-resistant microorganisms and frequent toxicity of topical medications, CXL may be a potential treatment for corneal infections. However, corneal infection is itself a possible complication of this treatment. We describe a case of severe corneal thinning and melting in a woman who had a CXL procedure as a treatment for herpetic keratitis., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

We report a case where corneal perforation developed during Nd:YAG laser capsulotomy. We present a 20-year-old male with the complaint of impaired vision in the right eye. Leukoma consistent with the incision line in the cornea and opacity in the posterior capsule were observed.

Introduction: Lamellar Ichthyosis is an autosomal recessive, inherited skin disorder characterized by thickening, fissuring and scaling of the skin., Objective: To report a case of lamellar icthyosis and highlight the importance of monitoring corneal health in these patients., Case: We report a rare case of bilateral spontaneous corneal perforation in a patient with lamellar ichthyosis .The patient presented with complaints of diminution of vision, foreign body sensation, watering and discharge in both of his eyes for the last three months followed by pain and redness for one week. Visual acuities were light perception in both the eyes. Cicatricial ectropion was seen in both the lower eyelids. Corneal perforation was seen in both the eyes. Lamellar ichthyosis was diagnosed on the basis of scaling and excessive dryness of the entire body skin and was confirmed by skin biopsy. Peneterating keratoplasty of both eyes was done with cataract surgery of the right. The systemic anti-ichthyosis therapy was started. Ectropion of the right eye was corrected, and on follow-up at three months, the patient had a visual acuity of 4 /60 and CFCF in the right and the left eye respectively., Conclusion: In patients with cicatricial ectropion and dry eye secondary to ichthyosis, corneal health should be closely monitored because of the perforation risk., (© NEPjOPH.)

Introduction: Phenylalanine (Phe) deficiency and its clinical manifestations have been previously described mostly as sporadic case reports dating back to the 1960's and 1970's. In these reports, low plasma Phe levels were associated with listlessness, eczematous eruptions and failure to gain weight, most often in infants in their first year of life., Case Report: Herein we describe a 9 month old female patient with known phenylketonuria, who presented with an unusual constellation of symptoms, including severe erythema and desquamation, alopecia, keratomalacia, corneal perforation, failure to thrive and prolonged diarrhea. The diagnostic possibilities of acrodermatitis enteropathica and vitamin deficiencies were ruled out, and further investigation into her medical history led to the conclusion that during the weeks preceding the hospitalization, the patient's diet consisted of the phenylalanine-free medical formula alone, without the addition of a standard infant formula or food as recommended. Subsequently, dietary control of the blood phenylalanine levels brought swift and marked resolution of the dermatological lesions, with renewal of hair growth., Objective: Following this experience, and due to the relative paucity of data regarding the clinical manifestations of low serum phenylalanine levels in humans and their putative pathogenetic mechanisms, we sought to further investigate the effects of a phenylalanine-free diet in a mouse study., Materials and Methods: For this purpose, twenty mice were randomly allocated to receive either a phenylalanine-deficient diet (n=10) or a normal diet (n=10). Weight was measured weekly, and laboratory tests were obtained including complete blood count, electrolyte studies, and phenylalanine and tyrosine levels. Finally, necropsies and histopathological examinations of different tissues were performed in selected mice, either early after diet initiation, late after diet initiation or following re-introduction of normal diets. The study was then repeated in additional two groups of mice, for a period of up to thirteen weeks, with a total of 63 mice., Results: Gross lesions noted on necropsy in the Phe-deficient mice included scruffy coat, tendency toward weight loss, a reduction in thymic mass, and most notably severe gastric dilation, all of which were not seen in the controls. Histologic findings included thymic depletion, hepatocellular vacuolation, and exocrine pancreatic atrophy. No histopathological lesions were evident in the brain, nor were significant lesions in the eyes., Conclusions: Diagnosis of the iatrogenic condition of phenylalanine deficiency, which manifests in gastrointestinal, dermatological and ocular findings, requires a high index of suspicion. Mice fed a phenylalanine-deficient diet display to some extent similar organ involvement, although no eye abnormalities were evident., (© 2013.)

A 61-year-old woman presented with a paracentral buttonhole flap defect associated with a linear tear, extensive epithelial ingrowth, and macrostriae in the right eye. A laser in situ keratomileusis enhancement had been performed 3 weeks earlier. The epithelial ingrowth was removed after careful lifting of the flap, and tissue adhesive was used postoperatively as a barrier to further ingrowth. Six months postoperatively, the patient's corrected distance visual acuity had improved to 20/20 and the slitlamp examination showed no evidence of recurrent epithelial ingrowth. This case presents a novel approach to the management of a buttonhole defect., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the use of fibrin glue to seal microperforations in Descemet membrane (DM) during deep anterior lamellar keratoplasty (DALK)., Methods: Two patients with keratoconus underwent DALK complicated by DM microperforation. Fibrin glue was successfully used to seal the microperforation in both cases., Results: DM remained attached postoperatively in both cases, with no opacification, increased inflammation, or vascularization of the corneal stroma., Conclusions: The use of fibrin glue for managing microperforations in DALK may be a viable option.

Purpose: To evaluate the efficacy of a novel technique of anterior segment reconstruction and cyclodialysis in patients with anterior staphyloma., Methods: A prospective case series of 8 consecutive patients who underwent anterior segment restoration with penetrating keratoplasty and cyclodialysis was analyzed. The main parameters evaluated were structural success of the graft, improvement in visual acuity, and intraocular pressure., Results: The globe could be salvaged in all the cases, and 75% (6 of 8) of the cases had clear graft at 6-month follow-up. Best-corrected visual acuity (BCVA) ranged from hand motion close to face to 6/12. None of the patients developed glaucoma during the follow-up period., Conclusions: Intraoperative creation of a cyclodialysis cleft can aid in adequate postoperative intraocular pressure (IOP) control and hence decrease the likelihood of graft failure because of raised IOP in eyes predisposed to development of postkeratoplasty glaucoma.

Purpose: To report a patient with bilateral corneal perforations and autoproptosis in a case of ocular Munchausen's syndrome., Design: Case report., Participant: A 26-year-old white male referred to the oculoplastics service with one month history of decreased vision bilaterally and painful right eye. Multiple eyelid scars and right corneal opacity were noted. The patient was previously seen at another institution for rapid loss of vision in both eyes., Interventions: An orbit decompression among many procedures failed to controlled extreme pain and proptosis., Main Outcome Measures: Resolution of proptosis, stabilization of vision, pain resolution., Results: Three weeks after enucleation of the right eye was offered, patient presented with spontaneous left ruptured globe. After multiple episodes of self-mutilation and infections, both eyes were exenterated., Conclusions: Munchausen syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnosis when ocular abnormalities cannot be explained after a thorough evaluation. Recognition of this psychiatric disease is not only important for correct medical diagnosis and treatment, but also essential in protecting the patients from unnecessary invasive and aggressive medical procedures.

The review of literature is devoted to up-to-date tendency of pharmacological treatment of corneal ulcers. Depending on cause of corneal inflammation treatment should be effective using appropriate etiotropic and pathogenetic treatment. Evaluating the literature data it is obvious that a number of questions is still should be studied. Thereby a search of new effective pharmacological treatment options with minimal side effects is essential. In case of progressing ulceration with threatened corneal perforation an urgent surgery is essential.

A variety of corneal pathology can lead to corneal ulcers and perforations. A deep corneal ulcer may need surgical treatment to allow good volume restoration and reepithelisation. Corneal perforation must be sealed and when the perforation is large, the task of repairing the defect can be underwhelming. The elegant solution is the corneal transplant, but this is not always readily available, especially in undeveloped countries. We present here two cases with different solutions to seal the perforated cornea: the first one has a large peripheral defect and it is successfully sealed with scleral patch and the second one is central with small perforation and is successfully sealed with multilayered amniotic membrane. Both cases are followed for over 12 months and demonstrate good corneal restoration (both on clinical examination and corneal topography). Sclera and amniotic membrane can be used to seal corneal defects when corneal transplant is not readily available.