J Korean Ophthalmol Soc.  2015 Aug;56(8):1278-1283. 10.3341/jkos.2015.56.8.1278.

A Case of Tectonic Lamellar Corneal Patch Graft Using Acellular Cornea in Corneal Ulcer Perforation

• Park JY
• Suh ES

• KMID: 2215083
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1278

Abstract

PURPOSE
We report a case of tectonic lamellar corneal patch graft using acellular corneal tissue (Halo Sterile Cornea; Lions VisionGift, Portland, OR, USA) for treating a large corneal ulcer perforation
CASE SUMMARY
A 72-year-old male previously treated for corneal ulcer was referred after presenting with decreased vision and abrupt tears in the right eye. His best-corrected visual acuity was 0.025 (20/800) and slit-lamp examination showed collapsed anterior chamber and 2 x 2 mm corneal perforation with protruded iris at the peripheral cornea. Infiltration in superficial stroma was observed near the perforation. Despite conjunctival flap, the cornea showed leakage due to perforation. To preserve ocular integrity, the patient underwent tectonic lamellar corneal patch graft using acellular corneal tissue. After surgery, the corneal patch graft was well attached. Re-epithelialization occurred after 3 days. There was no recurrence of perforation or corneal graft melting. Visual acuity improved to 0.32 (20/63) after 6 months.
CONCLUSIONS
Tectonic lamellar corneal patch graft using acellular corneal tissue can be a useful treatment option in large corneal ulcer perforation located at the periphery.

Keyword

Acellular cornea; Corneal ulcer perforation; Patch graft

MeSH Terms

Aged
Anterior Chamber
Cornea*
Corneal Perforation
Corneal Ulcer*
Freezing
Humans
Iris
Lions
Male
Re-Epithelialization
Recurrence
Tears
Transplants*
Visual Acuity

Figure

• 

  Figure 1. Anterior segment photograph at the initial presentation. The slit-lamp examination reveals large peripheral corneal ul-cer perforation with collapsed anterior chamber. Central ante-rior chamber depth was measured of 2 corneal thickness.

• 

  Figure 2. Anterior segment photograph after conjunctival flap. The next day, after conjunctival flap, the slit-lamp ex-amination reveals wound leakage and collapsed anterior cham-ber, despite conjunctival flap.

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  Figure 3. Anterior segment photograph at POD 1. The next day, after tectonic lamellar patch graft, the slit-lamp examina-tion reveals well attached corneal patch graft without leakage. POD = postoperative day.

• 

  Figure 4. Anterior segment photograph at POD 3. Three days after tectonic lamellar patch graft, the graft was re-epi-thelialized with normal anterior chamber depth and BCVA of 0.08 (20/250), due to irregular astigmatism. POD = post-operative day; BCVA = best corrected visual acuity.

• 

  Figure 5. Anterior segment photograph at POD 1 month. 30 days after patch graft, the slit-lamp examination revealed clear graft with normal anterior chamber depth and BCVA of 0.1 (20/200). POD = postoperative day; BCVA = best corrected visual acuity.

• 

  Figure 6. Anterior segment photograph at POD 6 month. After 6 months, the cornea maintained its contour and struc-ture without any complications, with BCVA of 0.32 (20/63). POD = postoperative day; BCVA = best corrected visual acuity.

• 

  Figure 7. Topography and dual Scheimpflug image at POD 6 month. The anterior axial curvature map showed asymmetric bowtie pattern which was superonasally steep (the oppsite site of patch graft). The corneal pachymetry map showed relatively even corneal thickness. The elevation map shows slightly elevated shape at the patch graft site. POD = postoperative day.

• 

  Figure 8. Dual Scheimpflug image of the cornea at POD 6 months. The dual Scheimpflug image of the previously perfo-rated area, shows well attached graft, and relatively normal contour of the anterior and posterior corneal surface. POD = postoperative day.

Reference

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