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 .
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 .
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 .
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 .
corneal perforation caused by small corneal punctures can sometimes be managed with a bandage soft contact lens , patching , and/or tissue adhesive [ 2 , 3 , 4 ] .
however , surgical intervention is usually indicated when the anterior chamber does not reform within a short period of time .
herein , we report the successful experience of managing a small paracentral corneal perforation without good apposition , which could not be tamponaded by a soft bandage lens only , with iatrogenic iris incarceration followed by cyanoacrylate tissue adhesive .
a 41-year - old man noted irritation in the right eye and was diagnosed to have a piece of metallic foreign body in his right cornea .
iatrogenic corneal perforation was encountered , while the attending physician attempted to remove the residual rust ring with a corneal burr .
slit - lamp examination revealed a paracentral corneal penetration with a diameter of approximately 0.5 mm ( fig .
the anterior chamber was flat , and active aqueous leakage was confirmed by a positive seidel test with fluorescein .
intravenous antibiotics with cefozopran hydrochloride were initiated , in conjunction with prophylactic topical antibiotic with 0.5% levofloxacin three times daily .
after 48 h of treatment , there was no significant improvement in the right eye .
concerns were raised about possible complications such as secondary angle closure glaucoma and prolonged hypotony .
since the puncture was located paracentrally near the visual axis , simple primary closure of the wound or corneal patch graft was deemed undesirable .
as the wound was completely  punched out , injected viscoelastic materials in the anterior chamber came out from the wound , which made it quite difficult to dry the surface of the cornea for application of tissue adhesive . therefore , to provide a necessary support for the gluing ,
amniotic membrane plugging was tried , but it was too slippery to be fixed on the wound .
a paracentesis port was created . a blunt 27-gauge needle ( with a 2-mm bent tip ) attached to a viscoelastic injecter
was gently inserted into the anterior chamber through the paracentesis . using the bent tip , a small tug of iris
care was taken not to touch or injure the corneal endothelium or anterior capsule of the lens .
meticulous drying of the wound and incarcerated iris was performed and a tiny amount of ethyl-2-cyanoacrylate adhesive ( aron alpha a ; sankyo co. ltd . ,
attention was paid to ensure that the glue did not spread on to the surrounding cornea .
the corneal puncture was thus successfully closed without any sutures , and the anterior chamber remained well formed .
postoperatively , the patient was treated with topical 0.1% fluorometholone and 0.5% levofloxacin three times daily .
pupillary distortion was observed when the iris was dilated ; however , the patient felt no visual disturbance .
herein , we reported a case of iatrogenic paracentral corneal perforation without good apposition successfully treated with autologous iris incarceration and cyanoacrylate adhesive .
conventionally , small corneal perforations were treated with stitches with or without corneal patch graft , tissue adhesives [ 2 , 3 , 4 ] , and recently with amniotic membrane and fibrin glue .
the indications for the use of a bandage soft contact lens to treat a corneal laceration include small wounds with good apposition , good alignment of the wound edges , and no incarceration or prolapse of the uvea or lens .
corneal puncture wounds of less than 2.0 mm in size can usually heal without being sutured . in this case , the wound was relatively small ( less than 1 mm ) , but the apposition of the wound was not optimal due to a sharply demarcated punch , which made restoring the anterior chamber extremely difficult using a bandage soft contact lens only . in cases with good apposition ,
a small amount of viscoelastic materials through the perforation site is often enough to allow safe application of tissue adhesive without gluing intraocular contents .
the technique described in this case appears useful secondary to the minimal residual scarring and related astigmatism .
a second advantage of this technique is that the iris is introduced to the perforation site from inside the eye in a controlled manner to prevent excessive iris prolapse and provide a stable support for the tissue adhesive .
this is more adequate than the use of an amniotic membrane , which is very slippery and difficult to be fixed on the wound .
furthermore , this technique requires no foreign tissue , thereby eliminating the risk of immunological tissue reactions .
the tissue adhesive may also theoretically circumvent the potential risks of epithelial down - growth by preventing corneal epithelium from growing directly over the iris .
this technique is safe and effective for paracentrally located corneal perforation ; however , significant synechiae involving the angle could prove to be problematic when the perforation is more peripheral .
very small descemet 's membrane transplantation instead of iris incarceration may be the other option for this situation . in conclusion ,
application of cyanoacrylate adhesive following iatrogenic incarceration of the iris seems to be simple and effective in managing small paracentral corneal perforations without good apposition .
 backgroundsurgical 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.casea 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.observationsthe 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.conclusionscyanoacrylate 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 . 
Background
Case
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Introduction
Case Report
Discussion
Disclosure Statement