J Korean Ophthalmol Soc.  2020 Nov;61(11):1358-1363. 10.3341/jkos.2020.61.11.1358.

Lamellar Graft of an Acellular, Preserved Human Cornea for Recurrent Anterior Granuloma in Stevens-Johnson Syndrome

• Lee SH
• Bae SH
• Kim KW

• KMID: 2511273
• DOI: http://doi.org/10.3341/jkos.2020.61.11.1358

Abstract

Purpose
We describe a patient with Stevens-Johnson syndrome who exhibited recurrent anterior corneal granulomas after corneal perforation (despite multiple amniotic membrane [AM] transplantations); the patient was successfully treated by lamellar grafting of an acellular, preserved human cornea.
Case summary
Corneal granulomas developed four times in a 46-year-old man who had been diagnosed with Stevens-Johnson syndrome 17 years priorly and who had undergone multiple AM transplantations after corneal perforation. A corneal granulomatous mass recurred 2 months prior to presentation in our clinic; it rapidly increased in size. With the patient under general anesthesia, the corneal mass was excised and a 4.0-mm-diameter, acellular preserved human cornea (Halo; Eversight Inc., Palo Alto, CA, USA) was grafted. A similarly sized AM was placed over the grafted cornea. Although the engrafted cornea exhibited stromal infiltration 1 month after surgery, the keratitis improved following brief antibiotic treatment. At 8 months postoperatively, the wound was stable; no granuloma recurrence, no graft melting, and no suspected microbial keratitis were observed in the region of the graft.
Conclusions
In patients with Stevens-Johnson syndrome and recurrent anterior granulomas (despite multiple AM transplantations), a lamellar graft of acellular, preserved human cornea may be a good therapeutic choice.

Keyword

Corneal granuloma; Lamellar keratoplasty; Preserved cornea; Stevens-Johnson syndrome