Clinical Characteristics, Management, and Visual Outcomes of Spontaneous Corneal Perforation: A Single-Center Retrospective Study in South Korea.

PURPOSE: To describe the clinical characteristics, etiologies, management patterns, and visual outcomes of spontaneous corneal perforation.

METHODS

We retrospectively reviewed 18 eyes of 17 patients with spontaneous corneal perforation treated at a tertiary center in South Korea between 2014 and 2022 with follow-up through December 2024. Cases were classified as noninfectious, infectious, or mixed. Clinical features, interventions, and visual outcomes were analyzed. Univariate analyses were performed to examine associations between clinical and demographic variables and final visual acuity.

RESULTS

The mean patient age was 58.0 ± 25.1 years. Noninfectious etiology accounted for 50.0% of cases; patients in this group were significantly younger than those with infectious or mixed etiologies (41.0 ± 26.8 years vs. 73.1 ± 9.4 years, p = 0.036). Blepharokeratoconjunctivitis (BKC) was the most common cause in younger patients, while neurotrophic keratopathy with superimposed infection predominated in older patients. Primary surgical treatments included amniotic membrane transplantation (50.0%), corneal patch graft (38.9%), and penetrating keratoplasty (16.7%), with 38.9% requiring more than one procedure. Final best-corrected visual acuity was significantly better in the noninfectious group than in the combined infectious/ mixed group (0.86 ± 1.14 logMAR vs. 2.19 ± 1.02 logMAR, p = 0.038). Final visual acuity was significantly correlated with age (Spearman rho = 0.738, p = 0.003); patients with systemic comorbidities also showed significantly worse outcomes (p = 0.008), a finding that may partly reflect confounding by age.

CONCLUSIONS

Spontaneous corneal perforation shows distinct clinical patterns by etiology and age. Younger patients with noninfectious disease achieved more favorable visual outcomes, while older patients with infectious or mixed etiologies more often required repeated interventions focused on globe preservation. Early recognition and sustained management of BKC in younger patients and close monitoring of corneal integrity in older patients with neurotrophic keratopathy may reduce the risk of progression to perforation.