Endothelial Keratoplasty with Amniotic Membrane Transplantation for Corneal Perforation in the Setting of Severe Ocular Surface Disease

ABSTRACT: Corneal perforation can significantly undermine corneal integrity in patients with severe ocular surface disease (OSD) and escalate to serious ocular sequelae and vision loss. The primary objective of this study is to report the technique and outcomes of non-Descemet stripping automated endothelial keratoplasty using the suture pull-through insertion method for the treatment of perforation in the setting of severe OSD rather than traditional penetrating keratoplasty. Three patients with corneal perforation complicated by severe OSD who underwent non-Descemet stripping automated endothelial keratoplasty at the Illinois Eye and Ear Infirmary between May 2023 and January 2025 were reviewed retrospectively. Information about preoperative patient's characteristics, surgical technique, and postoperative outcomes was extracted. All three patients achieved structural integrity with successful sealing of the perforation at the last follow-up. Postoperatively, all grafts remained attached in the area of perforation. No signs of infection or rejection were observed in any operative eye. Best-corrected visual acuity significantly improved in most cases. Endothelial keratoplasty with amniotic membrane transplantation offers an alternative approach for the treatment of perforation in patients with severe OSD and can be considered in selected cases to avoid further compromise to corneal nerves and epithelial complications that are frequent with full-thickness grafting in these patients.