P-17 Tri-lamellar mini-DSEK for repair of intractable corneal perforations

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Introduction Recurrent corneal perforations can be challenging to treat, especially in cases of chronic ocular inflammation. We highlight a novel technique for the definitive treatment of corneal perforations not amenable to therapy with cyanoacrylate glue. Methods We report two cases of large corneal perforations secondary to active rheumatoid arthritis. The cases had perforations that failed to seal after several attempts of cyanoacrylate glue and bandage contact lenses. A novel technique- Tri-lamellar tectonic Mini-Descemet Stripping Endothelial Keratoplasty (Mini-DSEK) along with amniotic membrane transplant (AMT) was used to restore anatomical integrity with success in both cases. In addition to the mini-DSEK patch, an overlay stromal cap was harvested from the same donor tissue and used as a patch graft, ‘sandwiched’ in between the DSEK tissue and the AMT. The AMT and patch were secured in position with fibrin glue, sutures and a BCL that provided additional strength. The sutures were removed at one month. Results Both had deep anterior chambers with no leak post operatively. The stromal cap is thin, transparent and adds tissue in the area of thinning. This tri-lamellar technique provides structural integrity, transparency, has anti-inflammatory properties, promotes re-epithelialization and ocular surface healing. Discussion Tectonic mini-DSEK with an overlay stromal cap is a novel procedure for corneal perforations which may be used as an alternative to anterior surgical approaches like penetrating or lamellar keratoplasty- reducing astigmatism and the risk of immunological rejection. The tri-lamellar technique adds tissue in areas of thinning and provides early visual rehabilitation.

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