Management of perforations during epikeratoplasty for keratoconus

Epikeratoplasty (EKP) in keratoconus generally has few intraoperative complications. Perforations during EKP are rare but may force the surgeon to abandon the procedure. We developed a special suture technique to manage this problem. Several deep mattress sutures are placed by taking shallow bites of the central corneal rim and deep bites of the peripheral corneal rim. This leaves the peripheral corneal rim projecting forward by approximately one third the corneal thickness. Slight stretching of this peripheral corneal rim allows adaptation of the epilenticule to form a smooth tissue plane. This method was used in two patients with significant corneal scarring and led to satisfactory visual results.