Management of a small paracentral corneal perforation using iatrogenic iris incarceration and tissue adhesive

Abstract

Background: Surgical intervention for corneal perforation is indicated when the anterior chamber does not reform within a short period of time. Herein, we report the successful management of a small paracentral corneal perforation using autologous iris incarceration and tissue adhesive.

Case: A 41-year-old man developed a small paracentral corneal perforation (0.5 mm in size) in the right eye, while the treating physician attempted to remove the residual rust ring after removal of a piece of metallic foreign body.

Observations: The eye was initially managed with a bandage soft contact lens to ameliorate the aqueous leakage; however, without success. Iatrogenic iris incarceration of the wound was first induced, followed by application of cyanoacrylate tissue adhesive to the perforated site. As a result, the anterior chamber was immediately reformed and maintained. Complete corneal epithelialization of the perforation was achieved in 2 months without visual compromises.

Conclusions: Cyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation. This technique is simple and potentially useful for small paracentral corneal perforations outside the visual axis and without good apposition.

Keywords: Corneal perforation; Cyanoacrylate; Iris incarceration; Tissue adhesive.

Fig. 1

Anterior photograph of the right eye at the initial visit. The cornea has been completely punched through by the drill and the anterior chamber is absent.

Fig. 2

Postoperative stage of the wound. Two weeks postoperatively, the corneal surface is smooth and shows a small scar. The anterior chamber is deep, with the edge of the pupil (5 o'clock position) attached behind the posterior cornea.