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.