Background:Small incision refractive lenticule extraction (SMILE) is an effective laser procedure that treats myopia.This research was to describe a novel approach to treat ceal ulcer or perforation using the ceal lenticules obtained from SMILE and to evaluate the safety and effectiveness of tectonic keratoplasty with femtosecond laser intrastromal lenticule (TEKIL).Methods:A total of twenty patients (22 eyes) were monitored for at least 6 months and were assessed using slit lamp microscopy,optical coherence tomography,and best-corrected visual acuity (BCVA).Postoperative complications throughout the study period were recorded.Results:Ceal ulcer in 14 patients (16 eyes) and ceal perforation in six patients (6 eyes) were treated with TEKIL.The patients were ten females and ten males,with a mean age of 58.5 ± 16.3 years (range:16-81 years).In this study,the most causes of ceal ulcer or perforation were immunologic causes (54.5％).After TEKIL procedure,global integrity was achieved in all cases.No immune rejection or perforation was detected.The mean BCVA improved from 0.17 ± 0.20 preoperatively to 0.27 ± 0.25 postoperatively at the final follow-up (t =2.095,P=0.052).The postoperative BCVA improved in 12 eyes (54.5％) and maintained in nine eyes (40.9％).Vision function successfully maintained in all eyes (100％).In three cases,ceal ulcers were treated by reoperation of TEKIL at 3 months after the initial surgery for the reason that the residual ceal thickness was ＜250 μtm.Conclusions:TEKIL seems to be an effective treatment for ceal ulcer and perforation in the condition of emergency and donor shortage.