Abstract

Intraoperative perforation is a dreaded complication of deep anterior lamellar keratoplasty(DALK) which can sometimes lead to conversion to penetrating keratoplasty.
Perforations can happen during big bubble formation and opening, during blunt dissection or even during initial trephination.
The principles of managing: Form air tamponade of AC, Avoid perforation extension, Seal it, Complete remaining dissection and Suture carefully.
In this video case series, we look at different types of perforation and its management both manual and big bubble DALK for varied etiologies. These situations were managed with a mix of rescue techniques – switching to a manual dissection, usage of fibrin glue or suture to seal the perforations, avoiding excess dissection and adjusting the initial suture locations.
In case of perforation a surgeon should never give up and always try to rescue DALK whenever possible. Planning and prudent on-table decisions, most perforations can be successfully DALK'd!