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Mechanism of fluid leak in non-traumatic corneal perforations: an anterior segment optical coherence tomography study
  1. Amna AlMaazmi1,2,
  2. Dalia G Said1,3,
  3. Marco Messina1,
  4. Ahmed AlSaadi2,
  5. Harminder Singh Dua1
  1. 1Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2Ophthalmology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
  3. 3Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt
  1. Correspondence to Professor Harminder Singh Dua, Ophthalmology, University of Nottingham, Nottingham NG7 2UH, UK; harminder.dua{at}


Aim Non-traumatic corneal perforations (CPerfs) may present with shallow/flat or formed anterior chamber (AC). This study uses anterior segment optical coherence tomography (ASOCT) to ascertain these differences.

Method The study included 14 eyes of 13 patients. They underwent high-resolution ASOCT scans at multiple time points, prior to and after cyanoacrylate glueing, between January 2016 and July 2018. A retrospective analysis of over 2500 ASOCT sections and AS photographs was conducted by two independent observers. The findings were correlated with clinical features and diagnoses.

Result All patients had documented Seidel’s positive sign at the outset. Two groups with distinctive features were identified. In group 1, ‘formed’ AC, there was hydration of the cornea with lamellar separation of the stroma, intrastromal pockets of fluid, epithelial bullae and an indirect communication between AC and the exterior. In group 2, ‘flat’ AC, the corneal hydration was less obvious, there were no pockets of intrastromal fluid, no epithelial bullae and a direct communication of the AC with the exterior. After glueing, the stromal hydration resolved, and healing occurred beneath the glue. The glue and corneal blood vessels consistently cast a dense shadow posteriorly on ASOCT.

Conclusion ASOCT demonstrates that leaking CPerfs can be indirect or direct. The former is associated with a ‘formed’ AC and the latter with a very shallow/flat AC. The valvular nature of the communication in indirect perforations allows the AC to maintain its volume despite a continuous leak.

  • cornea
  • imaging
  • wound healing
  • diagnostic tests/investigation

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  • Contributors All the authors contributed to the collection, analysis and evaluation of the scans and images. A AlSaadi and HSSD wrote the initial draft of the manuscript and all the authors reviewed and contributed comments and changes. DGS and A AlMaazmi generated the videos and analysis. The final manuscript was approved by all the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests HSSD: Honoraria and travel expenses from Dompe, Croma, Santen, Allergan and Thea, and shares in NuVision and GlaxoSmithKline.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved as a ‘clinical effectiveness audit’ by the Nottingham University Hospitals NHS Trust (No. 19-132C) and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.