Management of traumatic corneal perforations with anterior lamellar techniques: The mini-DSAEK
Reviewed by Ben Smith

The authors present the first case report in which a mini (reduced diameter) Descemet’s stripping automated endothelial keratoplasty (mini-DSAEK) has been used to manage a traumatic corneal perforation. A 69-year-old male presented with 6/36 best spectacle-corrected visual acuity (BSCVA) and a flat anterior chamber (AC) due to a metallic foreign body. On examination, there was a 2.5mm temporal corneal perforation with iris plugging which was managed with the well-established method of cyanoacrylate glue (CAG) and drape patch. One day postoperatively, the wound was leaking with iris plugging and the patient received a mini-DSAEK. Follow-up was at one week then one, three, six and nine months. Donor corneal tissue was split into two lamellae using a 300μm microkeratome and the posterior lamella cut using a 4mm skin punch; one side of this graft was trimmed tangentially to the optical radius by a further 1mm. A further CAG patch had to be placed over the perforation site to allow the AC to be re-formed with balanced salt solution. The tissue was mounted on a Busin glide, pulled into the AC and positioned underneath the site of the perforation, the AC filled with air and a bandage contact lens placed in-situ. There were no postoperative complications and the BSCVA improved to 6/12 at one month to 6/6 at nine months with keratometric astigmatism of 1.1 with a deep AC at all follow-up points. Whilst anterior lamellar techniques have been used for corneal perforations from other pathologies, this report demonstrates its use in the setting of trauma. The fact no sutures are used reduces the likelihood of inducing astigmatism and increases the speed of visual recovery as suture removal is not required. Further, compared to a full-thickness graft, the chance of rejection is lower. This represents a possible addition to the toolkit of the corneal surgeon when faced with traumatic perforation, but repeated success is required before conclusions can be made.

Tectonic mini-DSAEK facilitates closure of corneal perforation in eyes with healthy endothelium.
Seifelnasr M, Roberts HW, Moledina M, et al.
CORNEA
2021;40(6):790–3.