Early Endothelialization of Ab Interno Stromal Tectonic Patch in the Management of Corneal Perforation Secondary to Bacterial Keratitis

Abstract

Purpose:The purpose of this study was to describe a novel surgical technique using an ab interno stromal patch to treat corneal perforation and to present the histological findings of the patch after its removal during definitive mushroom keratoplasty.Methods:The endothelium had already been removed with the submerged cornea using backgrounds away (SCUBA) technique.Results:The patient was managed successfully with a sutureless ab interno stromal tectonic patch. Two months later, definitive mushroom keratoplasty was performed and the patch was sent for histological examination. Immunohistochemistry revealed a reactive endothelium covering the posterior surface of the graft. Nine months later, her best-corrected visual acuity was 6/9.Conclusions:This is the first case to our knowledge demonstrating that stromal tectonic grafts without the endothelium can successfully attach to the host tissue and seal a perforation. The stroma may undergo reendothelialization and begin to restore vision, even before penetrating keratoplasty.

Therapy for contact lens-related ulcers

“…However, there is concern for higher reinfection risk due to retained infectious material or infectious seeding of the anterior chamber by Descemet membrane rupture [78,80]. A recent case report has described a newer technique of an ab interno stromal patch graft for repair of perforation in a patient with bacterial keratitis [81].…”