{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T23:44:52Z","timestamp":1784072692440,"version":"3.55.0"},"reference-count":33,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,12]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>Managing large corneal perforations in severe dry eye disease (DED) is often challenging. We describe such a case that was successfully managed with a temporary tectonic posterior corneal lamellar graft. A patient with Sjogren\u2019s syndrome presented with filamentary keratitis and was inappropriately prescribed G. Maxitrol (Novartis, USA) along with lubricants. She returned in 6\u2009days with bilateral corneal melts, which was worse in her left eye. The left eye had a large corneal perforation and a flat anterior chamber. She underwent an emergency temporary tectonic posterior lamellar graft to form the anterior chamber. Two 9'0 Prolene limbus-to-limbus sutures were placed to buckle the graft on the host posterior cornea. This graft was kept in situ for 3\u2009months before removal. The melt and perforation self-healed with a scar, and 9\u2009months after the original surgery, the patient\u2019s vision improved to 6\/9 with a scleral contact lens.<\/jats:p>","DOI":"10.1136\/bcr-2024-262304","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T09:35:19Z","timestamp":1738575319000},"page":"e262304","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Temporary tectonic posterior corneal lamellar graft without Descemet\u2019s stripping for ab-interno sealing of large corneal perforation in severe dry eyes"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0667-3700","authenticated-orcid":false,"given":"Mayank A","family":"Nanavaty","sequence":"first","affiliation":[{"name":"Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandit M","family":"Nanavaty","sequence":"additional","affiliation":[{"name":"Queen Mary University of London Faculty of Medicine and Dentistry, London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"2025082701262438000_18.2.e262304.1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.survophthal.2011.06.003","article-title":"Management of corneal perforation","volume":"56","author":"Jhanji","year":"2011","journal-title":"Surv Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2016-308618"},{"key":"2025082701262438000_18.2.e262304.3","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.ajo.2007.12.020","article-title":"Primary diseases of corneal perforation in Shandong Province, China: a 10-year retrospective study","volume":"145","author":"Xie","year":"2008","journal-title":"Am J Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.4","doi-asserted-by":"crossref","first-page":"485","DOI":"10.4103\/joco.joco_107_21","article-title":"Prophylactic Use of Nonsteroidal Anti-Inflammatory Drugs after Cataract Surgery and Corneal Melt","volume":"33","author":"Ashena","year":"2021","journal-title":"J Curr Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.5","doi-asserted-by":"publisher","DOI":"10.1097\/00003226-200005000-00011"},{"key":"2025082701262438000_18.2.e262304.6","doi-asserted-by":"publisher","DOI":"10.1089\/jop.2019.0060"},{"key":"2025082701262438000_18.2.e262304.7","first-page":"163","article-title":"Persistent Corneal Epithelial Defects: A Review Article","volume":"8","author":"Vaidyanathan","year":"2019","journal-title":"Med Hypothesis Discov Innov Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.8","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1177\/112067210601600602","article-title":"Rheumatoid keratolysis: a series of 40 eyes","volume":"16","author":"Malik","year":"2006","journal-title":"Eur J Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.9","first-page":"462","article-title":"Tenon\u2019s Patch Graft: A Review of Indications","volume":"37","author":"Kate","year":"2022","journal-title":"Surgical Technique, Outcomes and Complications Semin Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.10","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2147\/OPTH.S394454","article-title":"Tissue Adhesives for the Management of Corneal Perforations and Challenging Corneal Conditions","volume":"17","author":"Sharma","year":"2023","journal-title":"Clin Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.11","doi-asserted-by":"crossref","first-page":"161","DOI":"10.4103\/0974-620X.142608","article-title":"Recurrent microbial keratitis in eyes with keratoconjunctivitis sicca with coexisting ocular surface pathology","volume":"7","author":"Nanavaty","year":"2014","journal-title":"Oman J Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.12","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/ijo.IJO_1151_19","article-title":"Management of corneal perforations: An update","volume":"68","author":"Deshmukh","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.13","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.survophthal.2021.04.002","article-title":"A review of filamentary keratitis","volume":"67","author":"Weiss","year":"2022","journal-title":"Surv Ophthalmol"},{"key":"2025082701262438000_18.2.e262304.14","doi-asserted-by":"crossref","unstructured":"Murtagh P , Comer R , Fahy G . 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