Win32-specific things, and ActiveX, isn't an area where perl/Tk is powerful.

For sure MSAA applications are not cross-platform, and, if you're targeting Win32 only, then probably another GUI engine will suit better.

Few years ago I developed applications from some Win32 IDEs, and had perl bindings, quite easy and powerfull.

When talking about perl/Tk, most chances for MSAA will have Tcl::Tk cpan module, look at http://vkonovalov.ru/cgi-bin/perl-tcltk-wiki.cgi/41 and http://vkonovalov.ru/perl-tcltk.htm