Retrocorneal Scleral Patch Supported Glue: A Technique for Management of Corneal Perforation and Corneoscleral Melt following Pterygium Surgery

To describe a new method of treatment of corneal perforation with extensive corneoscleral melt.

Case Report: 

A 42-year-old man presented with moderate-sized (3.5 mm) corneal perforation with extensive corneo-limbo-scleral ulceration following bare sclera excision of pterygium. No prior use of antimetabolites or postoperative beta radiation noted. We considered retrocorneal sclera patch supported cyanoacrylate application. The sclera was thinned to one-third thickness and a patch (4.5×4.5 mm) was punched. The sclera patch was placed on the iris, behind the corneal perforation, adequately covering it from inside. A minimal amount of adhesive was applied on the retrocorneal sclera patch and margin of corneal perforation. The ulcerating sclera was covered with double layered amniotic membrane. Topical antibiotic, steroid, and cycloplegic drops were instilled thrice daily. Corneal perforation healed and no recurrence occurred during the 18 months’ follow-up.

Retrocorneal scleral patch supported cyanoacrylate is effective for corneal perforation with corneo-scleral melt.