Tectonic DSAEK with phacoemulsification: a unique approach to manage corneal perforation with advanced cataract in a patient with rheumatoid arthritis.

Management of large corneal perforations in patients with rheumatoid arthritis is often challenging. It is further challenging when associated with advanced cataracts. We describe a case of corneal perforation in a patient with secondary Sjogren's syndrome, which was initially managed with cyanoacrylate glue and amniotic membrane as temporising measure. However, during the follow-up at 8 weeks, he developed advanced cataract in the same eye. He was successfully managed with a tectonic posterior corneal lamellar graft with phacoemulsification and intraocular lens (IOL) implantation. Phacoemulsification was performed with glue in situ, as trypan blue dye leakage was observed at the beginning of the procedure. Successful capsulorrhexis and low flow settings during phacoemulsification with anterior chamber maintainer during lenticule insertion lead to a successful end result with a clear cornea and in the bag IOL placement. The patient's vision improved to 6/9 with a scleral contact lens. All along this period, systemic immunosuppression was maintained.