**7. Surgical management**

Treatment of the underlying disease and management of the local inflammation is crucial in cases of PUK associated with an autoimmune etiology. Surgical procedures for PUK should be performed only after adequate immunosuppression, therefore reducing the risk of subsequent corneal graft melts or rejection, recurrence, and exacerbation of the inflammatory changes [4, 5]. However, this is often not possible. In the case of the most severe complication of PUK, corneal perforation, urgent surgical intervention is required despite the current immune status. The surgical method is selected based on the extent of corneal thinning or perforation and the severity of the ocular condition.

Indications for surgical management of PUK:

