Tectonic descemet stripping automated endothelial keratoplasty for the management of sterile corneal perforations in decompensated corneas

Purpose: To report the use of Descemet stripping automated endothelial keratoplasty (DSAEK) for treatment of sterile corneal perforations accompanying endothelial decompensation. Methods: In this multicenter interventional case series, we reviewed the medical records of all tectonic DSAEK surgeries performed at Villa Serena-Villa Igea private Hospitals (Forlì, Italy) and Rabin Medical Center (Petach Tikva, Israel) between January 2014 and March 2016. Results: Three patients with endothelial decompensation and sterile corneal perforation (n 2) or impending corneal perforation (n 1) underwent DSAEK between 2014 and 2015 at Villa Igea Hospital, Forlì, Italy, and Rabin Medical Center, Petach Tikva, Israel. All 3 surgeries were performed in eyes with a history of progressive stromal thinning without signs of infection, using the standard DSAEK technique. In 1 eye, surgery was complicated by bleeding into the graft-recipient interface that resolved after intraoperative interface washout. The other 2 procedures were uneventful. In all cases, the graft formed an airtight and watertight barrier, restoring the globe's mechanical integrity. All grafts remained clear throughout follow-up. One eye underwent deep anterior lamellar keratoplasty (DALK on DSAEK) with resulting improvement of visual acuity. Conclusions: Standard DSAEK can be performed in the presence of corneal perforation. Surgery can be a simple technique for closure of sterile corneal perforations while treating endothelial decompensation. Internal tamponade by a lamellar graft can possibly be used in cases of corneal perforations in eyes with a healthy endothelium.