title: Tectonic Descemet Stripping Automated Endothelial Keratoplasty for the Management of Sterile Corneal Perforations in Decompensated Corneas.
abstract: OBJECTIVE
  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.
authors.affiliation: *Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel;†Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;‡Department of Ophthalmology, "Villa Igea" Hospital, Forlì, Italy; and§Istituto internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Nahum
authors.forename: Irit
authors.initials: I
authors.lastname: Bahar
authors.forename: Massimo
authors.initials: M
authors.lastname: Busin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015715:Corneal Edema / Q000175:diagnosis / Q000601:surgery*; D057112:Corneal Perforation / Q000175:diagnosis / Q000601:surgery*; D003319:Corneal Stroma / Q000473:pathology; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology