One donor cornea for three corneal transplants, including a novel surgical technique of combined tight suturing to reduce and crescentic lamellar grafting to strengthen Terrien's marginal degeneration

We successfully utilized one donor cornea for three patients: firstly, a crescentic lamellar keratoplasty for Terrien's marginal degeneration; secondly, Descemet's membrane endothelial keratoplasty for Fuchs endothelial dystrophy; and finally, deep anterior lamellar keratoplasty for an advanced keratoconus patient. All three grafts were prepared during the first surgery, and the other two grafts were preserved and used on another day. Patients were followed up for 1 year, and all have good visual outcomes with stable grafts. Our first patient underwent a novel combined surgery of tight sutures for ectasia reduction that is usually performed at an earlier stage, with tissue augmentation using a lamellar graft meant for the later stage of the disease. With a successful outcome of up to 1-year follow-up, this technique can be considered in other suitable peripheral ectasias in the future. By sharing our experience, we hope that corneal surgeons and their patients at large will benefit.