Tectonic lamellar keratoplasty: Simplified management of corneal perforations with an automated microkeratome

Objective To describe a simplified tectonic lamellar keratoplasty (LK) technique, which can be used to manage full-thickness corneal perforations. Design Case series demonstrating a new surgical technique. Participants A 69-year-old female with rosacea keratitis and peripheral corneal perforation; a 49-year-old male with keratoconus, ipsilateral herpes simplex keratitis and an inferonasal corneal perforation; and a 12-year-old female with an apparently spontaneous central corneal perforation. Results These 3 patients with full-thickness corneal perforations were successfully managed with this automated tectonic LK technique. Conclusions Tectonic LK has benefits relative to tectonic penetrating keratoplasty but remains unpopular because it is technically difficult to prepare the host and donor corneas. This tectonic LK technique negates the need for challenging free-hand dissection and gives an excellent donor fit to the host bed. This provides an easier and more effective way to manage corneal perforations.