Tectonic epikeratoplasty with ethanol-stored donor corneas

Abstract

To evaluate the efficacy and outcomes of tectonic epikeratoplasty with use of ethanol-preserved corneal grafts for the management of perforated corneal melts. The present retrospective case series includes 10 eyes which underwent tectonic epikeratoplasty for perforated corneal melts. The stromal remainders of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation were stored in 95% ethanol and used as emergency tectonic grafts for restoring globe integrity after sterile and infectious perforated corneal melts. In 6 cases with subtotal corneal melt, DMEK remainders (endothelium-denuded corneoscleral buttons) were used for 'limbus to limbus' tectonic epikeratoplasty and in 4 cases DSAEK remainders (anterior stroma) were used to seal focal perforated melts. Graft storage time was 5.1 ± 4.9 (ranging from 0.5 to 17) months. The surgeries were successful in all cases with restitution of the globe integrity. During the postoperative course 4 cases developed a graft melt (corneoscleral button for limbus to limbus tectonic epikeratoplasty, n = 3; lamellar patch, n = 1) within 2-6 months after the initial procedure. Three patients underwent successful repeat tectonic epikeratoplasty. In the fourth case of graft melt the globe was enucleated due to underlying expulsive haemorrhage and severe pain. The short-term results of the present case series suggest that the use of ethanol-stored stromal remainder of donor corneas after endothelial keratoplasty is an efficient temporary measure for tectonic restoration of perforated corneas.

Tectonic Eccentric Penetrating Sclerokeratoplasty à chaud as Treatment for Peripheral Perforated or Predescemetal Corneal Ulceration

“…Occurrence of a postoperative transplant fusion in 4 of 10 eyes (40 %) when stroma tissue that had been stored in ethanol was used represents an efficient, albeit temporary, measure for tectonic restoration of perforated corneas. [14] In our case series, re-fusion of the corneal transplant was observed in 2 of the 14 eyes (14.3 %), a much lower rate than reported in the results cited above.…”

“…Lazaridis et al berichten über eine erfolgreiche Wiederherstellung eines intakten Bulbus bei großflächigen kornealen Verschmelzungen mit Hornhautresten, die nach DSAEK-und DMEK-Transplantationen in Ethanol eingelagert wurden. Das Auftreten einer postoperativen Transplantatverschmelzung bei 4 von 10 Augen (40 %) bei der Verwendung von ethanolgespeichertem Stromagewebe stellt eine effiziente und dennoch vorübergehende Maßnahme für die tektonische Wiederherstellung perforierter Hornhäute dar [14]. In unserer Fallserie zeigte sich eine erneute Verschmelzung des Hornhauttransplantats bei 2 von den 14 Augen (14,3 %), diese Rate ist deutlich geringer im Vergleich zu den o. g. Ergebnissen.…”

<p>Brittle cornea syndrome: current perspectives</p>

“…Epikeratoplasty is historically a refractive procedure in which the host corneal epithelium is removed and a donor lenticule is placed onto the recipient cornea, secured with sutures until it heals into place resulting in this technique being referred to as a “living contact lens.” It is not used routinely as a refractive procedure nowadays given the advantages of modern laser refractive surgery, although it has been utilised as a temporary measure for tectonic restoration of perforated corneas following corneal melts 41…”

Pericardium Patch Graft for Severe Corneal Wound Burn

“…On the contrary, Tutoplast ® patch graft's sutures are removed once the tissue disintegrates, hence less irregular astigmatism will be induced and there will be significantly reduced risk of suture-related complications and rejection. A patch of glycerol or ethanol preserved cornea 6 could be another option, however, considering the temporal location of the wound, the thick preserved cornea would cause irritation with each blink and trigger further eye rubbing. Alternatively, a patch of temporalis facia could be harvested from the same side of the surgery with the assistance of an oculoplastic surgeon and grafted to the defect.…”

“…Corneal wound burn is an uncommon complication of phacoemulsification surgery 1 that can result in further complications including high astigmatism, 2 corneal edema, and wound leak, 2 and endophthalmitis. 3 Several methods of treating corneal deficit and persistent wound leak have been described in the literature including cyanoacrylate or fibrin glue, 4 amniotic membrane (AM) patch graft, 5 ethanol or glycerol preserved corneal patch graft, 6 tectonic full thickness or lamellar corneal graft, 7 and conjunctival flap. 8 This case documents a previously unreported use of Tutoplast ® (Innovative Ophthalmic Products, Inc., Costa Mesa, CA, USA) human pericardium patch graft in managing persistent wound leak and corneal gaping wound after phacoemulsification and lens implant surgery.…”