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Updated: Nov 7, 2025
Corneal Donor Tissue Preparation for Endothelial Keratoplasty
Published on: June 12, 2012
Mini-DSAEK for Macro Corneal Perforations
Alfonso Vasquez-Perez1, Nizar Din1, Maria Phylactou1
1Cornea & External Diseases Department, Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom; and.
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.
Insights
This study introduces mini-Descemet stripping endothelial keratoplasty (EK) to repair corneal macroperforations, preserving vision and avoiding complex surgeries. The technique successfully sealed perforations, offering a viable alternative for patients with poor visual potential.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Tissue Engineering
Background:
- Corneal macroperforations pose significant challenges, often requiring tectonic keratoplasty with high risks of poor visual outcomes and graft rejection.
- Traditional lamellar or penetrating keratoplasty techniques may be unsuitable for eyes with limited visual potential or those at high risk of rejection.
Observation:
- A novel mini-Descemet stripping endothelial keratoplasty (mini-DESEKT) technique was developed and tested in a wet laboratory setting to address paracentral corneal macroperforations.
- The technique involves introducing a minidisc graft through the perforation and securing it with a double mattress suture to prevent graft herniation.
Findings:
- Laboratory tests confirmed mini-DESEKT effectively seals macroperforations without large incisions, preserving ocular integrity.
- Clinical application in three cases demonstrated successful outcomes, including unaided 20/15 vision in one case and long-term stability in two cases with limbal stem-cell deficiency.
Implications:
- Mini-DESEKT offers a promising alternative to conventional tectonic keratoplasty for paracentral corneal perforations, potentially improving visual prognosis.
- This approach facilitates host tissue preservation and may reduce the risk of rejection in high-risk patients, enhancing graft survival.
