Yonsei Med J.  2016 Jan;57(1):269-271. 10.3349/ymj.2016.57.1.269.

Tectonic Lamellar Keratoplasty Using Cryopreserved Cornea in a Large Descemetocele

• Kim KY
• Jung JW
• Kim EK
• Seo KY
• Kim TI

• KMID: 2466381
• DOI: http://doi.org/10.3349/ymj.2016.57.1.269

Abstract

We describe herein a case of an impending corneal perforation with a large descemetocele in a patient with previous penetrating keratoplasty (PKP) that subsequently was treated with an emergent lamellar keratoplasty using frozen preserved cornea. A 76-year-old male patient, who had a PKP, presented with a completely whitish and edematous graft accompanied by large epithelial defects. Although antibiotics and antiviral agents were tried for three days, the corneal stroma abruptly melted, except for the Descemet's membrane and endothelium. Cryopreserved corneal tissue that was kept at -80degrees C was thawed and sutured on top of the remaining Descemet's membrane and endothelium. Pathological and microbiological tests were conducted using the remaining donor and recipient corneal tissues. After tectonic corneal transplantation on top of a large descemetocele, a healthy graft and relatively clear interfaces between graft-host junctions were maintained without serious adverse reactions throughout 6 month follow-up period. Microbiological evaluations of donor tissue at the time of thawing and tissue preparation were done, and the results were all negative. Tissue that was taken intraoperatively from the recipient cornea also showed negative microbiological results. In conclusion, tectonic lamellar keratoplasty, using cryopreserved corneal tissue, only onto the remaining Descemet's membrane and endothelium in an emergent condition, was a safe and effective treatment.

Keyword

Tectonic keratoplasty; cryopreserved cornea; descemetocele

MeSH Terms

Cornea/*surgery
Corneal Perforation/pathology/physiopathology/*surgery
Corneal Transplantation/*methods
*Cryopreservation
Eye Injuries, Penetrating/pathology/physiopathology/*surgery
Female
Humans
Keratoplasty, Penetrating
Male
Middle Aged
*Tissue Donors
Treatment Outcome
Visual Acuity

Figure

• 

  Fig. 1 Slit lamp photograph of cornea taken preoperatively and postoperatively. (A) A photograph of the cornea 1 day before the operation. The stroma of the corneal graft melted down with preservation of only the Descemet's membrane and endothelium. (B) Six months after the operation, an intact corneal graft with mild interface opacity is shown.

• 

  Fig. 2 Serial sections of cornea using RTvue optical coherence tomography. (A) Day 10, (B) 1 month, and (C) 6 months after lamellar graft. Each corneal section reveals double layers of endothelium, indicated by arrowheads.

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