Abstract
RATIONALE: Primary watertight scleral closure is the standard approach for the treatment of open globe injuries. However, in cases with posterior globe rupture, surgical access may be severely limited, making direct suturing impossible. In such cases, alternative methods are required to preserve globe integrity and prevent phthisis. This report describes a rare case of posterior globe rupture, for which primary scleral suturing was not feasible, successfully managed with a scleral onlay human pericardial graft. PATIENT CONCERNS: A 75-year-old woman presented with no light perception vision and total hyphema after blunt trauma to the right eye. DIAGNOSES: Imaging suggested a zone III globe rupture located posterior to the equator with inverted scleral margins, which was confirmed by exploratory surgery. INTERVENTIONS: Emergency surgery was performed under general anesthesia. A preserved human pericardial graft was trimmed and placed in an onlay fashion to cover the scleral wound. Only the anterior graft margin was sutured to the sclera, and a 2nd pericardial graft was overlaid to provide additional tectonic support. The conjunctiva was repositioned over the graft. OUTCOMES: Postoperatively, intraocular pressure and globe contour were maintained for at least 4 months, although vision did not improve. No signs of infection or graft displacement were observed during the follow-up. LESSONS: A scleral onlay pericardial graft with minimal anterior fixation can be a valuable technique for preserving ocular integrity in posterior globe ruptures in which primary closure is not possible. This approach may help to prevent phthisis and maintain the ocular surface for future prosthetic rehabilitation.