TechniquesMini-DSAEK for Macro Corneal PerforationsVasquez-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*,†Author Information *Cornea & External Diseases Department, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom; and †Department of Health's NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom. Correspondence: Alfonso Vasquez-Perez, MD, FRCOphth, FEBOS-CR, Cornea & External Diseases Service, Moorfields Eye Hospital, 162 City Rd, London EC1V 2PD, United Kingdom (e-mail: [email protected]). The authors have no funding or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.corneajrnl.com). Cornea: August 2021 - Volume 40 - Issue 8 - p 1079-1084 doi: 10.1097/ICO.0000000000002713 Buy SDC Metrics Abstract Purpose: 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. Method: 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. Results: 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. Conclusions: 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.