Bovine pericardium membrane (TutoPatch) for emergency repair of total corneal melting over an infected corneal graft

Alfonso Savastano; Emanuele Crincoli; Stanislao Rizzo

doi:10.1016/j.ajoc.2023.101885

Bovine pericardium membrane (TutoPatch) for emergency repair of total corneal melting over an infected corneal graft

Am J Ophthalmol Case Rep. 2023 Jul 13:32:101885. doi: 10.1016/j.ajoc.2023.101885. eCollection 2023 Dec.

Authors

Alfonso Savastano¹, Emanuele Crincoli^{1

2

3}, Stanislao Rizzo^{1

2

4}

Affiliations

¹ Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
² Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy.
³ Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, Avenue de Verdun, Créteil, 94100, France.
⁴ Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy.

Abstract

Purpose: Corneal perforation due to severe melting is a very dangerous, sight-threatening condition requiring immediate management due to the high risk of endophthalmitis and critical hypotony. In the case of perforated corneal grafts, retransplantation is usually postponed to avoid the detrimental effects of inflammation on the new graft. We describe the first case of the use of a TutoPatch graft for emergency replacement of a lamellar graft perforation over acute infectious total melting.

Observations: A 42-year-old male patient presented to the Emergency Department with pain in the left eye, which was red photophobic. He had been treated with bilateral deep anterior lamellar keratoplasty (DALK) for advanced keratoconus 5 years previously and had been experiencing recurrent corneal ulcers in the left eye within the last 8 months. Clinical examination documented corneal perforation over acute infectious melting involving the total graft surface in the left eye. The infected graft was removed along with the perforated infected residual Descemet membrane, and a double-layer TutoPatch covering was sutured to the host's margin with 10.0 nylon. The covering was left in place for three weeks, allowing the patient to undergo retransplant three weeks later without complications.

Conclusions and importance: TutoPatch covering can be safely used as an easy-to-preserve emergency material for a temporary bridge to retransplantation in large acute infectious corneal melting.

Keywords: Bacterial keratitis; Corneal graft; Corneal melting; Corneal perforation; DALK; TutoPatch.

Publication types

Case Reports