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Tectonic descemet stripping endothelial keratoplasty for the management of corneal perforation: A case series

Tectonic descemet stripping endothelial keratoplasty for the management of corneal perforation: A case series
Tectonic descemet stripping endothelial keratoplasty for the management of corneal perforation: A case series
Purpose:
Corneal perforations pose a considerable challenge for ophthalmic surgeons. The aim remains restoring the anatomical integrity of eye while attempting to preserve as much visual function as possible. To our knowledge, we report the first case series of 4 successful tectonic Descemet stripping endothelial keratoplasty (DSEK) grafts completed for acute corneal perforation. In all cases, restoration of globe integrity was achieved. In cases where visual potential remained, deep anterior lamellar keratoplasty over DSEK was offered.

Methods:
Four patients presenting to Royal Gwent Hospital (Newport, Wales) with corneal perforation were included. Etiological origins included exposure keratopathy, corneal hydrops secondary to pellucid marginal degeneration with fistulization-associated aqueous leak, and herpetic keratitis. Patients were treated with initial temporary therapies, including glue patch, the use of bandage contact lenses, amniotic membrane transplant, and antibiotic cover, depending on the size and location of the perforation. Subsequent DSEK was subsequently performed under local anesthesia.

Results:
All patients had successful tectonic grafts (3 DSEKs and 1 hemi-DSEK) up to 4 months postoperatively. In the case involving a hemi-DSEK, the patient underwent 2 refloating attempts of the graft before anchoring suture placement because of repeated graft detachment. Successful graft placement and tectonic globe restoration was confirmed by anterior segment imaging.

Conclusions:
Tectonic DSEK provides corneal surgeons with a new modality of treating corneal perforations. It provides clinicians an additional tool in their armamentarium in complex cases where anterior lamellar or penetrating keratoplasty may be contraindicated or deemed high risk of complications.
0277-3740
1571-1575
Tourkmani, Abdo Karim
c94ef0c2-903e-4d01-9c2f-11e05fc3f573
Ansari, Abdus Samad
0c84f598-eb05-4768-9075-cf3b5c3d70b6
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Konstantopoulos, Aristides
c54185a9-1ef3-4b6d-91a3-38de444cc4fb
Anderson, David
ace373df-c58c-4cd4-941f-1a596a62b5a8
Tourkmani, Abdo Karim
c94ef0c2-903e-4d01-9c2f-11e05fc3f573
Ansari, Abdus Samad
0c84f598-eb05-4768-9075-cf3b5c3d70b6
Hossain, Parwez
563de5fc-84ad-4539-9228-bde0237eaf51
Konstantopoulos, Aristides
c54185a9-1ef3-4b6d-91a3-38de444cc4fb
Anderson, David
ace373df-c58c-4cd4-941f-1a596a62b5a8

Tourkmani, Abdo Karim, Ansari, Abdus Samad, Hossain, Parwez, Konstantopoulos, Aristides and Anderson, David (2020) Tectonic descemet stripping endothelial keratoplasty for the management of corneal perforation: A case series. Cornea, 39 (12), 1571-1575. (doi:10.1097/ICO.0000000000002424).

Record type: Article

Abstract

Purpose:
Corneal perforations pose a considerable challenge for ophthalmic surgeons. The aim remains restoring the anatomical integrity of eye while attempting to preserve as much visual function as possible. To our knowledge, we report the first case series of 4 successful tectonic Descemet stripping endothelial keratoplasty (DSEK) grafts completed for acute corneal perforation. In all cases, restoration of globe integrity was achieved. In cases where visual potential remained, deep anterior lamellar keratoplasty over DSEK was offered.

Methods:
Four patients presenting to Royal Gwent Hospital (Newport, Wales) with corneal perforation were included. Etiological origins included exposure keratopathy, corneal hydrops secondary to pellucid marginal degeneration with fistulization-associated aqueous leak, and herpetic keratitis. Patients were treated with initial temporary therapies, including glue patch, the use of bandage contact lenses, amniotic membrane transplant, and antibiotic cover, depending on the size and location of the perforation. Subsequent DSEK was subsequently performed under local anesthesia.

Results:
All patients had successful tectonic grafts (3 DSEKs and 1 hemi-DSEK) up to 4 months postoperatively. In the case involving a hemi-DSEK, the patient underwent 2 refloating attempts of the graft before anchoring suture placement because of repeated graft detachment. Successful graft placement and tectonic globe restoration was confirmed by anterior segment imaging.

Conclusions:
Tectonic DSEK provides corneal surgeons with a new modality of treating corneal perforations. It provides clinicians an additional tool in their armamentarium in complex cases where anterior lamellar or penetrating keratoplasty may be contraindicated or deemed high risk of complications.

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Accepted/In Press date: 12 May 2020
e-pub ahead of print date: 1 July 2020

Identifiers

Local EPrints ID: 444415
URI: http://eprints.soton.ac.uk/id/eprint/444415
ISSN: 0277-3740
PURE UUID: 28524248-04ca-482e-8be3-50998c2ccbc4
ORCID for Parwez Hossain: ORCID iD orcid.org/0000-0002-3131-2395

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Date deposited: 16 Oct 2020 16:33
Last modified: 17 Mar 2021 02:39

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Contributors

Author: Abdo Karim Tourkmani
Author: Abdus Samad Ansari
Author: Parwez Hossain ORCID iD
Author: Aristides Konstantopoulos
Author: David Anderson

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