"Pocket" technique: a multiple-layer amniotic membrane transplant approach for managing graft-versus-host disease-associated corneal perforations.

AIM: To describe a modified technique using multiple-layer amniotic membrane (AM) to manage corneal perforations in graft-versus-host disease (GVHD). METHODS: This case series included three eyes from 3 patients with GVHD and corneal perforation who underwent AM transplantation between 2019 and 2020. AM was collected from human placenta shortly after the cesarean section. During surgery, the AM was folded and sutured into the wound to create an "AM pocket" into which small AM debris was placed. The pocket was then closed using a 10-0 nylon suture and covered with an AM seal. After re-epithelization and AM scarring, sutures were removed. RESULTS: All 3 patients achieved successful wound closure with a single surgery, and corneal thickness remained >300 µm at the 6-month follow-up. Visual acuity improved in patients with peripheral perforation. CONCLUSION: The "Pocket" AM transplantation technique is an effective option and recommend for treating acute corneal perforations in patients with GVHD. Our modified AM transplantation method provided definitive wound closure and successfully repaired wounds of various sizes without recurrent corneal melting or perforations.