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Case Reports in Ophthalmological Medicine
Volume 2012, Article ID 916528, 4 pages
http://dx.doi.org/10.1155/2012/916528
Case Report

Tectonic DSAEK for the Management of Impending Corneal Perforation

Department of Cornea and Refractive Surgery, Instituto de Oftalmologia “Conde de Valenciana”, Chimalpopoca 14, 06800 Mexico City, DF, Mexico

Received 24 October 2012; Accepted 19 November 2012

Academic Editors: N. Fuse, T. Hayashi, S. M. Johnson, and S. Schwartz

Copyright © 2012 Enrique O. Graue-Hernandez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. To report a case of severe corneal thinning secondary to dry eye treated with a tectonic Descemet stripping automated lamellar keratoplasty (DSAEK) and amniotic membrane graft. Methods. A 72-year-old man with a history of long standing diabetes mellitus type 2 and dry eye presented with 80% corneal thinning and edema on the right eye and no signs of infectious disease, initially managed with topical unpreserved lubrication and 20% autologous serum drops. Eight weeks after, the defect advanced in size and depth until Descemetocele was formed. Thereafter, he underwent DSAEK for tectonic purposes. One month after the procedure, the posterior lamellar graft was well adhered but a 4 mm epithelial defect was still present. A multilayered amniotic membrane graft was then performed. Results. Ocular surface healed quickly and reepithelization occurred over a 2-week period. Eight months after, the ocular surface remained stable and structurally adequate. Conclusion. Tectonic DSAEK in conjunction with multilayered amniotic graft may not only provide structural support and avoid corneal perforation, but may also promote reepithelization and ocular surface healing and decrease concomitant inflammation.