Tectonic Mini-Dsaek For Corneal Perforations: A Two-Centre Case Series

To report the clinical outcomes of tectonic mini–Descemet’s stripping automated endothelial keratoplasty (mini-DSAEK) for corneal perforation in five eyes, and to describe results with two technical strategies: sutureless versus anchored lenticule fixation.

Guy’s and St Thomas’ Hospital (London, United Kingdom) and Hospital Clínico Universitario de Valladolid (Spain).

Retrospective two-centre case series of five eyes undergoing tectonic mini-DSAEK. Mini-DSAEK lenticules were <5 mm in diameter and individually tailored to the perforation size, associated corneal thinning, and location. Aetiologies included corneal melting, Stevens–Johnson syndrome (bilateral), post-LASIK neurotrophic ulcer, and active herpetic keratitis (as a temporary measure prior to a definitive keratoplasty). Tectonic success was defined as a sealed globe with a formed anterior chamber and no persistent leak. Surgical technique differed by centre: sutureless mini-DSAEK (United Kingdom) versus anchored mini-DSAEK secured with sutures (Spain).

In all five eyes, globe integrity was restored after mini-DSAEK, with a stable anterior chamber and no persistent aqueous leak on follow-up visits, resulting in 100% tectonic success. Rebubbling was not required in any case, and complete epithelialisation occurred by post-operative day 14 in all eyes. The procedure was not associated with intraoperative or post-operative complications. Early post-operative stability was similar with sutureless versus anchored lenticule fixation, with no long-term differences observed between techniques. In the case of active herpetic keratitis, the procedure provided temporary stabilisation to enable penetrating keratoplasty once inflammation was controlled.

Tectonic mini–Descemet’s stripping automated endothelial keratoplasty appears to be a practical globe-preserving option for corneal perforation, particularly when tissue adhesives are unsuitable. In this case series, outcomes were comparable with sutureless and anchored lenticule fixation. The technique may also be considered as a bridge to later keratoplasty in selected eyes.