ESCRS - CR01.02 - TEMPORARY TECTONIC POSTERIOR CORNEAL LAMELLAR GRAFT WITHOUT DESCEMET'S STRIPPING FOR AB-INTERNO SEALING OF LARGE CORNEAL PERFORATION

TEMPORARY TECTONIC POSTERIOR CORNEAL LAMELLAR GRAFT WITHOUT DESCEMET'S STRIPPING FOR AB-INTERNO SEALING OF LARGE CORNEAL PERFORATION

Published 2025 - 29th ESCRS Winter Meeting

Reference: CR01.02 | Type: Case Report (Cornea Day) | DOI: 10.82333/4t35-tp33

Authors: Mayank Nanavaty* 1 , Vandit Nanavaty 2

1Sussex Eye Hospital,University Hospitals Sussex NHS Foundation Trust,Brighton,United Kingdom, 2Queen Marys University of London ,London,United Kingdom

Purpose

We describe a case of bilateral corneal melt in a severe DED patient with perforation in one eye, which was successfully sealed with temporary tectonic posterior lamellar keratoplasty without Descemet's stripping.

Setting

Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom

Report of case

We describe such a case which was successfully managed with a temporary tectonic posterior corneal lamellar graft. A patient with Sjogren's syndrome presented with filamentary keratitis and was inappropriately prescribed G. Maxitrol (Novartis, USA) along with lubricants. She returned in 6 days with bilateral corneal melts, which was worse in her left eye. The left eye had a large corneal perforation and a flat anterior chamber. She underwent an emergency temporary tectonic posterior lamellar graft to form the anterior chamber. Two 9'0 Prolene limbus-to-limbus sutures were placed to buckle the graft on the host posterior cornea. This graft was kept in situ for three months before removal. The melt and perforation self-healed with a scar, and nine months after the original surgery, the patient's vision improved to 6/9 with a scleral contact lens.

Conclusion / Take home message

  • Managing large corneal melt with perforation in the background of severe dry eyes is often challenging as keratoplasty may be the only option, with a significant risk of failure and rejection.
  • Allowing the melt and perforation to settle with the scar by forming the anterior chamber with a temporary tectonic posterior corneal lamellar donor graft gives excellent outcomes
  • When doing this procedure, do not expect this posterior corneal lamellar graft to attach at the perforation site in broader and larger perforations. However, the aim is for peripheral attachment by taking two limbus-to-limbus buckling sutures.
  • Remove this temporary posterior corneal lamella when the melt and perforation have settled. Visual rehabilitation can be performed with scleral contact lenses later.