Successful Management of Corneal Perforation Following Keratoplasty with Emergency Periosteal Grafting

Background: Corneal ulcers, if left untreated, can progress to perforation, threatening both vision and ocular integrity.When corneal donor tissue is unavailable, periosteal grafts provide a temporary solution to preserve eye structure and manage infection until definitive intervention becomes feasible.Case Report: A 39-year-old woman underwent a periosteal graft for a perforated corneal ulcer in her right eye.While the graft preserved the globe's integrity, her vision was limited to hand movement.In 2024, penetrating keratoplasty (PK) was performed, achieving a corrected distance visual acuity (CDVA) of 6/24 five months postoperatively with a clear graft.However, at seven months, CDVA decreased to 6/40 due to cataract progression, with cataract surgery planned to improve visual outcomes further.Conclusion: This case highlights the role of periosteal grafts in maintaining ocular integrity when donor tissue is inaccessible and demonstrates the potential for delayed PK to yield substantial visual improvement.Comprehensive postoperative care and planned cataract surgery are critical for optimizing long-term outcomes and enhancing patient satisfaction.