Suture Barricade Technique for Corneal Dermoid With Intraoperative Descemet Perforation in an Infant: A Case Report

Purpose: The aim of this study was to describe the surgical management and postoperative outcome of a visually significant limbal dermoid involving the central cornea in a 5-month-old infant, complicated by intraoperative Descemet membrane (DM) perforation and successfully managed with a modified rescue technique. Case Report: A 5-month-old male infant presented with a whitish mass over the left cornea that had been present since birth. Ocular examination revealed a vascularized, elevated limbal dermoid extending into the visual axis, measuring 8 × 8.5 mm. Considering the risk of amblyopia, surgical excision was planned under General Anesthesia. During lamellar keratectomy, an unintentional DM perforation of size 1.5 mm occurred. The perforation was immediately sealed with a same-sized stromal lamellar graft and an air bubble in the anterior chamber. The postoperative nonresolving corneal edema and DM detachment were managed with a “suture barricade” technique. Results: The postoperative period was uneventful, with a clear cornea, attached DM, and a satisfactory cosmetic outcome. Suture removal was performed after 3 months. Conclusions: The suture barricade technique for DM perforation presented here can enable successful lamellar keratectomy even in the context of deep limbal dermoid. The suture barricade technique may provide a viable option for managing small DM perforations in other contexts (eg, corneal hydrops or optical Deep Anterior Lamellar Keratoplasty) as well, without compromising corneal clarity or cosmesis.