Corneal Perforation Two Years After Mitomycin Intravascular Chemoembolization

ABSTRACT: Mitomycin intravascular chemoembolization (MICE) is a potential treatment for corneal neovascularization (NV) with encouraging early outcomes. We describe a case of focal corneal perforation occurring two years after MICE. A 65-year-old man with a history of penetrating keratoplasty performed 30 years earlier underwent MICE for treatment of corneal NV. Two years later, he presented with acute visual decline in the left eye. At presentation, the visual acuity was 20/200 improving to 20/50 with pinhole in the right eye and counting fingers improving to 20/400 in the left eye. Examination revealed a pinpoint Seidel-positive corneal perforation near the graft-host junction, occurring at the same site previously treated with MICE and adjacent to an area of prior corneal NV and lipid deposition. No trauma, infection, or autoimmune disease was identified. After three attempts of corneal gluing failed, a therapeutic corneal patch graft was performed. Postoperatively, the patient was treated with topical moxifloxacin four times daily and topical prednisolone acetate four times daily. The pinhole visual acuity improved to 20/250 with the pinhole. The anterior chamber remained formed and quiet. Although causality cannot be established, this case raises the possibility of delayed stromal weakening after MICE in a structurally vulnerable cornea and highlights the importance of long-term surveillance following this procedure.