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Case Reports
. 2023 Jul 13:32:101885.
doi: 10.1016/j.ajoc.2023.101885. eCollection 2023 Dec.

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

Alfonso Savastano  1 , Emanuele Crincoli  1   2   3 , Stanislao Rizzo  1   2   4
Affiliations
Case Reports

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

Alfonso Savastano et al. Am J Ophthalmol Case Rep. .

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.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Anterior segment photography of the preoperative condition shows the abscess covering almost the entire surface of the corneal graft with inferior leakage at the graft margin.
Fig. 2
Fig. 2
Anterior segment photography showing the 48-h postoperative condition of the operated eye.
Fig. 3
Fig. 3
TutoPatch covering in place 3 weeks post-operatively. The suture margins did not show any sign of dehiscence or inflammation, and the Seidel test was negative.
Fig. 4
Fig. 4
Picture taken during the secondary retransplantation procedure. The removed TutoPatch cover is intentionally split by the surgeon to show the double layer of the patch. The filamentous sides of both layers faced each other and were kept out of contact with the aqueous humor.
Fig. 5
Fig. 5
Final result after secondary penetrating keratoplasty.
Fig. 6
Fig. 6
Intraoperative keratoscopy showing minimal corneal astigmatism after penetrating keratoplasty.
See this image and copyright information in PMC

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