SCLERAL PATCH GRAFT IN CORNEAL PERFORATION: AN ALTERNATIVE TO CORNEAL PATCH.

To evaluate the visual and structural outcomes of scleral patch graft in patients with corneal perforations. 

Hospital del Salvador

We performed a retrospective case study of scleral patches in a tertiary and national eye trauma reference center between 2012 and 2023. Patients with previous history of scleral patch, patch not sutured to cornea and operated in a different center were excluded. The primary outcome was ocular surface stability, with additional analyses improvement of visual acuity.

13 eyes of 13 patients were analyzed. Seventy seven percent were male patients. The average age was 56,08 years (with a range of 15 to 83 years). The most common cause of corneal perforation was trauma (53,85%), followed by immune causes (15,38%). Three patients had previously received a cyanoacrylate patch. Patients were followed for 15,92 months on average (range from 1 to 52 months). During this period,  23% (3 patients) developed secondary perforations, one of which had to be eviscerated. One patient developed ptisis bulbi and another did not complete the follow up period. Overall, the rate of tectonic success was achieved in 83% of the eyes. In terms of visual acuity, before the intervention, 84,6% of the eyes were logMAR 0.5 or worse, 61,5% were unable to read the Snellen visual chart. After the intervention, 46,15% improved their visual acuity, on average gaining 6,3 lines on the Snellen chart.

The scleral patch graft is an adequate structural technique in patients with corneal perforation due to its better availability compared to corneal grafts. The evolution post procedure is variable and most likely influenced by the etiology of the perforation, resulting in secondary perforations and complications such as ptisis bulbi.