Tectonic epikeratoplasty: a surgical procedure for corneal melting

BACKGROUND AND OBJECTIVE: Tectonic epikeratoplasty (TEK) is a method in which a corneal button, preserved in glycerin is used as a seal over corneal perforation. The graft is sutured to the recipient sclera, upon the sick melted cornea, with silk sutures, after 360 degree peritomy of the conjunctiva. The graft is left in place for a few weeks, and by that time the cornea is completely healed. We describe our experience in TEK as a method of treatment for selected cases of melted cornea or descemetocele. METHODS AND PATIENTS: We review 12 TEK operations done in our department over the period of 1992 to 1997, and describe the outcome in each case. RESULTS: The 12 TEK operations included 9 eyes of 9 patients. The patients, 7 males and 2 females, suffered from ocular surface disturbances including indifference to pain syndrome, Steven-Johnson syndrome, dry eye, relapsing herpetic keratitis, post-traumatic corneal thinning, and local anesthetic abuse. Six of the 9 eyes had leaking perforated corneal ulcer, and the remaining 3 had an imminent perforation caused by descemetocele or melting. All the grafts but one fell off the eyes between 10 and 21 days following surgery. In most of the cases the leakage ceased, and a scar sealing the perforation site was observed. One eye had gone through this procedure 3 times, and another eye had gone through it twice. In only 3 cases did the procedure fail to eliminate leakage, and another TEK or urgent penetrating keratoplasty (PKP) was done. CONCLUSIONS: TEK is an available method for saving the integrity of the globe when PKP is not possible. Although it increases corneal vascularity, PKP can be done later under optimal conditions.