This is a variation on full width DSAEK for macroperforation in which a mini-DSEK is used to seal a macroperforation ab interno, with stroma or amniotic membrane layering up in fibrin glue to provide a framework for tissue regeneration in the corneal stromal defect.
My colleague at Moorfields, Alfonso Vasquez Perez, has done a fantastic video illustrating this technique and the accompanying lab work which we are shortly to publish in Cornea. We have set this in context here together with the principles of conventional tectonic grafting for an off-axis or peripheral corneal perforation.
Advantages for the miniDSEK technique both in terms of simplicity, preservation of a clear visual axis, and relative freedom from irregular astigmatism are clear, as is the potential for combining this approach with newer regenerative bioglues.
