Abstract

Author demonstrates genesis, prevention & treatment of occult perforation during PK in RK in OS. A 68-years-old female with poor phaco outcome was advised PK. Pre-op acetazolamide, mannitol & digital massage were used. A 7.5 mm trephine was centered and rotated without exerting any pressure. Mild tilt caused full thickness cut on nasal and no cut on temporal side. Corneal scissors cut nasal and inferior quadrant without ease, whereas in temporal and superior quadrant cutting of thicker cornea exerted stress on radial cuts. It caused opening of cuts seen as widening. While suturing, receipient corneal segments were held firmly, needle was advanced till there was no resistance, beyond that counter pressure was applied to avoid stress & opening of cuts. Occult perforations were closed with 10 o nylon sutures. At T points microleaks were detected & CTA was applied. Pre-op hypotony, deeper cut with vertical trephine & careful suturing can prevent perforations. Once occur need sutures & CTA.