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Tectonic DSEK for the management of corneal perforation: a case series

Poster Details

First Author: A.Ansari UK

Co Author(s):    A. Tourkmani                    

Abstract Details


Corneal perforations can be an unfortunate complication secondary to a number of pathologies posing a considerable challenge for ophthalmic surgeons. The ultimate aim remains to restore the anatomical integrity of the eye whilst simultaneously attempting to preserve as much visual function as possible. To our knowledge, we report the first case series of four successful tectonic Descemet’s Stripping Endothelial Keratoplasty (DSEK) grafts completed for acute corneal perforation. In all cases, complete restoration of the cornea was achieved. In cases where visual potential remained patients were subsequently offered Deep Anterior Lamellar Keratoplasty (DALK) over DSEK with promising results


4 patients presenting to Royal Gwent Hospital, Newport, Wales for corneal perforation were included. Aetiological origins included exposure keratopathy, corneal hydrops with fistulisation and aqueous leak, herpetic keratitis and pellucid marginal degeneration. Patients were treated with temporary interventions prior to the completion of surgery.


All patients were initially treated with temporary measures including glue patch grafts, the use of bandage contact lenses and antibiotic cover depending on the size and location of perforation. Under local anaesthesia, patients underwent DSEK graft surgery. Patients were all admitted overnight to facilitate posturing and to ensure an adequate position of the graft and tamponade of the corneal perforation. Positioning and subsequent epithelisation over the graft was confirmed by anterior segment Optical Coherence Tomography (OCT) within the department. All operations were completed by a consultant corneal surgeon well versed in this technique.


Successful positioning and clearing grafts were seen in all patients up to 4 months postoperatively. One patient who underwent Hemi-DSEK required multiple attempts of re-floating of the graft prior to permanent sutured placement. Successful re-epithelization and graft placement was confirmed by anterior segment imaging. Patients with good visual potential underwent subsequent DALK over DSEK with good visual outcomes.


Tectonic DSEK provides corneal surgeons with a unique modality of treating corneal perforations. It provides clinicians with an additional tool in their armamentarium in complex cases where anterior lamellar or penetrating keratoplasty may be contraindicated due to the nature of the inflamed corneal tissue or high complication rates including melting of the host tissue, loosening of associated sutures, the need for general anaesthesia and prolonged surgical time.

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