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CASE REPORT article

Front. Med.

Sec. Ophthalmology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1649417

The "Sandwich" Procedure for Paracentral Rheumatoid Corneal Perforation:A Case Report With 6-Year Follow-up and Literature Review

Provisionally accepted
Yi  ZhangYi Zhang1Hanjing  LiuHanjing Liu1Qing  LiQing Li1Yan  ZhuYan Zhu2*Yuguang  ZhuYuguang Zhu3*
  • 1Shandong Second Medical University, Weifang, China
  • 2Affiliated Hospital of Shandong Second Medical University, Weifang, China
  • 3Affiliated Hospital of Weifang Medical University, Weifang, China

The final, formatted version of the article will be published soon.

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease often associated with ocular manifestations. In rare cases of RA, paracentral rheumatoid corneal perforation may occur. We report the case of a 53-year-old monocular woman with a 20-year history of RA who presented to the clinic with a paracentral corneal perforation. Slit-lamp examination revealed a 2-mm diameter paracentral perforation with an iris plug. The patient was clinically diagnosed with sterile rheumatoid corneal perforation. We describe an innovative "sandwich" procedure developed for addressing the corneal perforation. Initially, a partial thickness limbal groove was created outside the perforation, followed by the formation of a semicircular intrastromal pocket extending approximately 2 mm inside the perforation edge. A lamellar graft was then fashioned and inserted into the intrastromal pocket. Subsequently, the limbal groove was closed, and a conjunctival flap was used to cover the perforated area. Upon follow-up, the "sandwich" procedure provided sufficient tectonic support for the patient's only eye, resulting in a stable ocular surface. Over a 6-year follow-up period, the postoperative best-corrected visual acuity (BCVA) was maintained at 20/50. To the best of our knowledge, this is the first report of the "sandwich" procedure for paracentral rheumatoid corneal perforation.

Keywords: "sandwich" procedure, case report, Corneal Perforation, Rheumatoid arthritis, intrastromal allograft keratoplasty

Received: 19 Jun 2025; Accepted: 24 Sep 2025.

Copyright: © 2025 Zhang, Liu, Li, Zhu and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Yan Zhu, zhuyg1972@qq.com
Yuguang Zhu, zhuyg@sdsmu.edu.cn

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