Tectonic graft patching and conjunctival resection is one of the effective treatment modalities in especially resistant PUK patients with corneal perforation additional to topical and systemic immunosuppressive treatment. A 44-year-old female patient with a 10-year history of rheumatoid arthritis, was referred to our clinic with peripheric corneal perforation. Her visual acuity was at the level of hand movement perception in the left eye. Slit-lamp examination revealed medial PUK with corneal perforation. Tectonic patch grafting was performed. Two weeks later, because of small melting area at the inferior part of the graft with iris incarceration, an additional cornea-scleral graft transplantation was performed. Due to the immune nature of the PUK, limbal conjunctiva at the perforation site was also resected. Three months after the re-grafting, there was no recurrence. Best corrected visual acuity was 5/10 log MAR in the left eye.
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