Sectoral Tectonic Keratoplasty With Frozen Corneal Stroma In A Case Of Corneal Perforation Due To Chronic Keratopathy.

Describe a clinical case of frozen stroma tectonic keratoplasty in a patient with recurrent corneal perforations

Surgical management of corneal perforations can be complex in many situations, as it depends on factors such as the location of the lesion, extension, depth of visual potential... being necessary the individualization  of each case.

We presen the case of a 42-year-old male with a history of corneal ulcers of autoinmune and herpetic etiology in both eyes. His only functional eye is the right one, where he presents a marginal ulcer with associated descemetacole on which amniotic membrane (AM) coverings were performed with subsequent thinning and recurrent perforations. 

Ophthalmological examination showed visual acuity (VA) in the right eye with light perception; biomicroscopy showed a new microperforation on a chronic thinning with associated descematocele; funduscopic examination was normal. 

Subsequent examination showed an increase in the size of the perforation despite intensive topical treatment with antibiotic therapy. 

Given the previous failures to cover the perforation with AM, the option of performing a tectonic sectorial keratoplasty with frozen donor cornea to cover the perforation until donors were available to perform a penetratin keratoplasty was considered. 

Under peribulbar anesthesia, 5 mm perileisional marking and partial keratectomy, 5 mm diameter trephination of the frozen stroma without endothelium, suturing of the graft with 10/0 Nylon loose stitches an placement of the therapeutic contact lens

Postoperatively: Complete sealing of the defect, increased tissue support in the deficient area and subsequent epithelization were achieved

Tectonic sector keratoplasty with frozen corneal stroma allowed us to succesfully cover the perforating defect and gave us time to be able to perform penetrating corneal keratoplasty at a later stage. 

In situations of graft shortage, this is a very effective bridge therapy when traditional options fail.