Bombuy Gimenez J, Izdebska J, Samelska K, Szaflik JP. Eccentric semilunar penetrating keratoplasty for peripheral corneal perforation following chemical eye injury: A case report. World J Clin Cases 2026; 14(20): 121742 [DOI: 10.12998/wjcc.121742]
Corresponding Author of This Article
Justyna Izdebska, MD, PhD, Associate Professor, Department of Ophthalmology, Medical University of Warsaw, Józefa Sierakowskiego 13, Warsaw 03-709, Mazowieckie, Poland. justyna.izdebska@wum.edu.pl
Research Domain of This Article
Ophthalmology
Article-Type of This Article
case-report
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World J Clin Cases. Jul 16, 2026; 14(20): 121742 Published online Jul 16, 2026. doi: 10.12998/wjcc.121742
Eccentric semilunar penetrating keratoplasty for peripheral corneal perforation following chemical eye injury: A case report
Jan Bombuy Gimenez, Justyna Izdebska, Katarzyna Samelska, Jacek P Szaflik
Jan Bombuy Gimenez, Justyna Izdebska, Jacek P Szaflik, Department of Ophthalmology, Medical University of Warsaw, Warsaw 03-709, Mazowieckie, Poland
Justyna Izdebska, Katarzyna Samelska, Jacek P Szaflik, Department of Ophthalmology, SPKSO Ophthalmic University Hospital, Warsaw 03-709, Mazowieckie, Poland
Author contributions: Bombuy Gimenez J and Izdebska J contributed to conceptualization, investigation; Samelska K and Izdebska J contributed to data curation; Izdebska J contributed to methodology; Bombuy Gimenez J contributed to writing - original draft, visualization; Bombuy Gimenez J, Samelska K, and Izdebska J contributed to writing - review and editing; Szaflik JP and Izdebska J contributed to supervision.
AI contribution statement: Claude (Sonnet 4.6) was used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-assisted outputs were critically reviewed and revised by the authors.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Justyna Izdebska, MD, PhD, Associate Professor, Department of Ophthalmology, Medical University of Warsaw, Józefa Sierakowskiego 13, Warsaw 03-709, Mazowieckie, Poland. justyna.izdebska@wum.edu.pl
Received: April 1, 2026 Revised: May 17, 2026 Accepted: June 2, 2026 Published online: July 16, 2026 Processing time: 100 Days and 8.8 Hours
Abstract
BACKGROUND
Ocular surface chemical injury is a sight-threatening ophthalmic emergency. Even if adequately treated in the acute phase, it may lead to severe complications, including corneal perforation, resulting in irreversible visual loss. Although early irrigation is the mainstay of initial treatment, advanced ocular surface chemical injuries complicated by corneal perforation often require tectonic surgical intervention for globe preservation. However, in selected cases with localized defects, limited corneal grafting may be sufficient, reducing surgical trauma to otherwise healthy corneal tissue.
CASE SUMMARY
A 65-year-old female with no prior ophthalmic history presented to the ophthalmology emergency department one day after sustaining a chemical eye injury at her workplace. Despite immediate on-site irrigation with normal saline and a neutralizing solution, she reported foreign body sensation, ocular pain, and decreased visual acuity. Examination revealed corneal melting and perforation in the inferior quadrant, a flat anterior chamber with iris incarceration, oval pupil displacement toward the perforation site, and ocular hypotony. The patient was admitted to our hospital and underwent tectonic corneal transplantation, in the form of eccentric noncircular penetrating keratoplasty, with a semilunar donor graft fashioned using 11.0 mm and 10.0 mm trephines. The incarcerated iris was repositioned, and viscoelastic was injected to stabilize the anterior chamber. Postoperatively, globe integrity was successfully restored, with subsequent improvement in visual acuity and marked enhancement in ocular comfort.
CONCLUSION
The semilunar graft represents a viable tissue-sparing approach for managing peripheral corneal perforations in selected cases with preserved corneal tissue.
Core Tip: Eccentric semilunar penetrating keratoplasty represents a viable tissue-sparing surgical option for managing acute peripheral corneal perforations secondary to chemical injury. This approach preserves the healthy central optical zone, minimizes antigenic load, and reduces the risk of immunologic rejection compared to total penetrating keratoplasty, while achieving the primary goal of globe salvage. However, the procedure presents significant technical challenges, including severe hypotony, anterior chamber collapse, and iris incarceration, requiring manual recipient bed preparation and viscoelastic-assisted chamber reformation. This emergency tectonic strategy preserves the central corneal architecture, maintaining the option for future optical keratoplasty if visual rehabilitation remains insufficient.
