International Ophthalmology

, Volume 39, Issue 10, pp 2275–2282 | Cite as

Stromal Patch with fibrin glue as a novel surgical technique to seal peripheral Descemet’s membrane perforations in deep anterior lamellar keratoplasty

  • Reza Ghaffari
  • Hamed Ghassemi
  • Golshan LatifiEmail author
  • Mahmood Jabbarvand
  • Alireza Zamzam
  • Hassan Hashemi
Original Paper



The purpose of this article was to introduce a novel surgical technique for the management of peripheral Descemet’s membrane perforation during deep anterior lamellar keratoplasty (DALK).


First, a thin stromal patch was prepared either from the anterior stromal lamella cut during DALK or from the anterior stroma of a Descemet’s stripping automated endothelial keratoplasty button. The stromal patch was secured in a stromal pocket dissected deep in the trephination edge along the perforation site. Fibrin glue was applied to the stromal patch. Finally, the graft was sutured to the recipient bed.


We used this technique in 3 cases with peripheral DM perforations during DALK. The first case was a persistent postoperative double anterior chamber who developed Urrets-Zavalia syndrome after air injection in an attempt to seal the perforation. In the second case, this technique was applied to seal an intraoperative DM perforation, without which the procedure would have been converted to penetrating keratoplasty. The third case had a persistent postoperative double chamber despite multiple air injections and fibrin glue application. The technique was effective in the management of all DM perforations with a resolution of double anterior chamber.


This technique is safe and effective as an intraoperative method or a postoperative measure to seal peripheral DM perforations. We recommend this technique for repairing peripherally located DM perforations during DALK not amenable to simple measures like air injection or fibrin glue application.


Deep anterior lamellar keratoplasty Double anterior chamber Fibrin glue Stromal patch 



We would like to thank Mrs. Baharak Salehi for her contribution to designing the schematic illustration of the technique.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were approved by the ethical committee of Farabi Eye hospital and were in accordance with the tenets of the Helsinki Declaration.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

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Supplementary material 1 (MP4 25121 kb)
10792_2018_1065_MOESM2_ESM.mp4 (10.9 mb)
Supplementary material 2 (MP4 11206 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Farabi Eye HospitalTehran University of Medical SciencesTehranIran
  2. 2.Noor Eye Research CenterNoor Eye HospitalTehranIran

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