Mini-DSAEK for Macro Corneal Perforations : Cornea

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Mini-DSAEK for Macro Corneal Perforations

Vasquez-Perez, Alfonso MD, FRCOphth, FEBOS-CR*; Din, Nizar MBBS, BSc, FRCOphth*; Phylactou, Maria MD, MSc, FEBO*; Kriman Nunez, Jaime MD*; Allan, Bruce MD, FRSC, FRCOphth*,†

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Cornea 40(8):p 1079-1084, August 2021. | DOI: 10.1097/ICO.0000000000002713



We present a technique that preserves good vision in paracentral macroperforations and avoids challenges of tectonic lamellar or penetrating keratoplasty in eyes with poor visual potential.


A wet laboratory was implemented for mini-Descemet stripping endothelial keratoplasty to seal macroperforations ab interno. This included a suture support technique designed to prevent graft herniation. We also present 3 cases who were treated successfully with this technique.


The laboratory test confirmed that mini-Descemet stripping endothelial keratoplasty can successfully seal macroperforations without the need of large incisions. The minidisc is introduced through the perforation, and a double mattress suture prevents graft herniation. The technique allowed us to preserve 20/15 unaided vision in a case with paracentral macroperforation. It also restored eye globe integrity and achieved long-term stability in 2 cases with limbal stem-cell deficiency.


Mini-Descemet stripping–automated endothelial keratoplasty technique can be an alternative approach to avoid poor visual outcomes of tectonic keratoplasty in paracentral perforations. It also offers host tissue preservation in eyes with high risk of rejection for tectonic grafts.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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