Temporary tectonic posterior corneal lamellar graft without Descemet’s stripping for ab-interno sealing of large corneal perforation in severe dry eyes

Managing large corneal perforations in severe dry eye disease (DED) is often challenging. We describe such a case that was successfully managed with a temporary tectonic posterior corneal lamellar graft. A patient with Sjogren's syndrome presented with filamentary keratitis and was inappropriately prescribed G. Maxitrol (Novartis, USA) along with lubricants. She returned in 6 days with bilateral corneal melts, which was worse in her left eye. The left eye had a large corneal perforation and a flat anterior chamber. She underwent an emergency temporary tectonic posterior lamellar graft to form the anterior chamber. Two 9'0 Prolene limbus-to-limbus sutures were placed to buckle the graft on the host posterior cornea. This graft was kept in situ for 3 months before removal. The melt and perforation self-healed with a scar, and 9 months after the original surgery, the patient's vision improved to 6/9 with a scleral contact lens.