AB-EXTERNO MINI DSAEK AS A SURGICAL SOLUTION FOR ACUTE CORNEAL PERFORATION CAUSED BY CHRONIC VITAMIN A DEFICIENCY.

To describe a definitive Ab externo sutureless mini-keratoplasty technique to treat a peripheric acute corneal perforation with local anesthesia. A 74-year-old man was presented to the Emergency department of our centre complaining of blurred vision and corneal opacity in her right eye. On examination, he presented corneal perforation in the right eye with decreased corneal thickness adjacent to the perforation and iris incarceration in the wound. Bitot spots and conjunctival xerosis were observed on the conjunctiva. As a general history, the patient reported bariatric surgery 15 years before. The patient underwent surgery but general anesthesia was not recommended due to the low oxygen saturation.

Anterior Segment Pathology Unit, Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain

We performed a preoperative OCT showing a corneal thinning in an area of 4 mm and the incarcerated iris in the central perforation of approximately 1 mm. Lamellar grafts were obtained from a donor cornea of the Eye Bank which had not been suitable for corneal transplantation due to a substantial endothelial cell loss. On a 100-micron endothelium and stroma lamella of the donor cornea, we performed a 4 mm trepanation for a mini DSAEK, and another of 3 mm to which we removed the endothelium. We injected some viscoelastic material through the perforated area to replace the incarcerated iris in the wound, then we introduced the lamella for DSAEK through the perforation and fixed it with an injection of air in the anterior chamber. We place biological glue on the area and fix the second lamella on the thinned cornea. We covered the area with biological glue, a 6 mm double amniotic membrane patch and a therapeutic contact lens.

The surgical technique allowed the definitive closure of the corneal perforation and the replacement of the incarcerated iris. We achieve good results with a quick surgery, without general anesthesia or sutures. We show the postoperative controls of the patient with images and OCT. the patient was treated with vitamin A supplements and we were able to perform cataract surgery two years later.

Chronic vitamin A deficiency can cause acute corneal perforation in patients with a history of bariatric surgery who have not received vitamin supplements. Ab-Externo sutureless bilamellar mini keratoplasty is a quick and effective technique for corneal perforation in compromised patients.