New Surgical Modality for Management of Corneal Perforation Using Bowman Membrane

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Purpose:To describe a new surgical modality, “Bowman membrane tuck-in,” for management of small to medium sized corneal perforation of a noninfectious etiology.Methods:Two patients with corneal perforation of a noninfectious etiology and less than 4 mm in size underwent Bowman membrane tuck-in, a new surgical procedure. In this technique, Bowman membrane harvested from the donor cornea was tucked inside the stromal pocket of host tissue, which was prepared by 360-degree anterior stromal lamellar dissection. Patients were followed up for 6 months and were examined for best-corrected visual acuity, epithelialization time, anterior chamber stability, and graft-related complications.Results:During 6-month follow-up, best-corrected visual acuity improved from PL+ (positive) to 20/120 and 20/200 in patient 1 and patient 2, respectively, and epithelialization was completed within a 2-week period in both patients. Surgery was uneventful in both cases; however, anterior chamber re-formation and graft repositioning were performed in patient 1. None of the patients showed signs of rejection or graft failure at 6-month follow-up.Conclusions:Bowman membrane tuck-in is an effective sutureless and glueless technique for management of corneal perforation of a noninfectious etiology, which may be used in emergency settings for the management of noninfectious corneal perforation of size less than 4 mm.

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