Korean J Ophthalmol.  2011 Apr;25(2):132-135. 10.3341/kjo.2011.25.2.132.

Tectonic Deep Anterior Lamellar Keratoplasty in Impending Corneal Perforation Using Cryopreserved Cornea

Affiliations
  • 1Department of Ophthalmology, Changwon Fatima Hospital, Changwon, Korea.
  • 2Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. changsd@dsmc.or.kr

Abstract

We report a case of tectonic corneal transplantation for impending corneal perforation to preserve anatomic integrity using cryopreserved donor tissue. An 82-year-old woman exhibiting impending corneal perforation suffered from moderate ocular pain in the left eye for one week. After abnormal tissues around the impending perforation area were carefully peeled away using a Crescent blade and Vannas scissors, the patient received tectonic deep anterior lamellar keratoplasty using a cryopreserved cornea stored in Optisol GS(R) solution at -70degrees C for four weeks. At six months after surgery, the cornea remained transparent and restored the normal corneal thickness. There were no complications such as corneal haze or scars, graft rejection, recurrent corneal ulcer, and postoperative rise of intraocular pressure. Cryopreserved donor lamellar tissue is an effective substitute in emergency tectonic lamellar keratoplasty, such as impending corneal perforation and severe necrotic corneal keratitis.

Keyword

Donor corneal cryopreservation; Impending corneal perforation; Tectonic deep anterior lamellar keratoplasty

MeSH Terms

Aged, 80 and over
Cornea/injuries/*surgery
Corneal Perforation/pathology/physiopathology/*surgery
Corneal Transplantation/*methods
*Cryopreservation
Eye Injuries, Penetrating/pathology/physiopathology/*surgery
Female
Follow-Up Studies
Humans
*Tissue Donors
Visual Acuity

Figure

  • Fig. 1 Corneal ulceration with impending corneal perforation was seen by slit lamp examination before tectonic deep anterior lamellar keratoplasty.

  • Fig. 2 Postoperative photography. (A,B) A cornea transplantation was performed with cryopreserved anterior lamellar tissue and was covered with an amniotic patch. (C,D) Six months later, the cornea maintained its contour and structure.


Cited by  1 articles

C-type Anterior Lamellar Keratoplasty Using Cryopreserved Leftover Cornea for Terrien's Marginal Degeneration
Kyu Young Shim, Jong Hwa Jun
J Korean Ophthalmol Soc. 2017;58(4):467-472.    doi: 10.3341/jkos.2017.58.4.467.


Reference

1. Marc AH, Christopher JR. Krachmer JH, Mannis MJ, Holland EJ, editors. Management of corneal perforations. Cornea. 2005. 2nd ed. Philadelphia: Mosby;1669–1684.
2. Vanathi M, Sharma N, Titiyal JS, et al. Tectonic grafts for corneal thinning and perforations. Cornea. 2002. 21:792–797.
3. Shimmura S, Tsubota K. Deep anterior lamellar keratoplasty. Curr Opin Ophthalmol. 2006. 17:349–355.
4. Ang M, Mehta JS, Arundhati A, Tan DT. Anterior lamellar keratoplasty over penetrating keratoplasty for optical, therapeutic, and tectonic indications: a case series. Am J Ophthalmol. 2009. 147:697–702.e2.
5. Brunette I, Le François M, Tremblay MC, Guertin MC. Corneal transplant tolerance of cryopreservation. Cornea. 2001. 20:590–596.
6. Halberstadt M, Bohnke M, Athmann S, Hagenah M. Cryopreservation of human donor corneas with dextran. Invest Ophthalmol Vis Sci. 2003. 44:5110–5115.
7. Chau GK, Dilly SA, Sheard CE, Rostron CK. Deep lamellar keratoplasty on air with lyophilised tissue. Br J Ophthalmol. 1992. 76:646–650.
8. Farias R, Barbosa L, Lima A, et al. Deep anterior lamellar transplant using lyophilized and Optisol corneas in patients with keratoconus. Cornea. 2008. 27:1030–1036.
9. Filatov VP. Transplantation of the cornea. Arch Ophthalmol. 1935. 13:321–347.
10. Donald JD. Krachmer JH, Mannis MJ, Holland EJ, editors. Tissue storage. Cornea. 1997. St. Louis: Mosby;509–517.
11. Polge C, Smith AU, Parkes AS. Revival of spermatozoa after vitrification and dehydration at low temperatures. Nature. 1949. 164:666.
12. Eastcott HH, Cross AG, Leigh AG, North DP. Preservation of corneal grafts by freezing. Lancet. 1954. 266:237–239.
13. Smith AU, Ashwood-Smith MJ, Young MR. Some in vitro studies on rabbit corneal tissue. Exp Eye Res. 1963. 2:71–87.
14. Corydon C, Hjortdal J, Ehlers N. Re-examination of organ-cultured, cryopreserved human corneal grafts after 27 years. Acta Ophthalmol. 2009. 87:173–175.
15. Alio JL, Shah S, Barraquer C, et al. New techniques in lamellar keratoplasty. Curr Opin Ophthalmol. 2002. 13:224–229.
16. Melles GR, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006. 25:987–990.
17. Frantz JM, Gebhardt BM, Reidy JJ, McDonald MB. Immunogenicity of epikeratophakia tissue lenses containing living donor keratocytes. Refract Corneal Surg. 1991. 7:141–145.
18. Kratz-Owens K, Huff JW, Kownacki JJ, et al. Long-term storage of frozen lenticules for cryorefractive surgery. J Cataract Refract Surg. 1990. 16:723–726.
19. Shi W, Liu M, Gao H, et al. Penetrating keratoplasty with small-diameter and glycerin-cryopreserved grafts for eccentric corneal perforations. Cornea. 2009. 28:631–637.
Full Text Links
  • KJO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr