Customised component corneal transplantation: a blessing for three patients

Donor cornea shortages remain a critical challenge in many developing countries. Standard corneal transplantation procedures typically use a single donor button for one recipient. Prior research has shown that this approach limits access to treatment for many patients. Alternative strategies have been proposed to maximize donor tissue use. However, no prior work had resolved how to safely divide a single donor cornea among multiple recipients. This gap motivated the exploration of customized component corneal transplantation. The goal was to determine if a single donor cornea could be divided into multiple usable components. No prior studies had demonstrated the use of a patch graft from a corneoscleral rim. This paper introduces a novel approach to address donor scarcity.

This case report aimed to demonstrate the feasibility of using a single corneoscleral button for three separate corneal transplantations. The specific problem addressed was the acute shortage of donor corneas in resource-limited settings. The motivation was to increase the number of patients who could benefit from a single donor tissue. The authors proposed that customized component corneal transplantation could be a practical solution. The approach involved dividing the donor cornea into anterior lamellar, posterior lamellar, and patch graft components. Each component was tailored to a specific patient's condition. The study sought to evaluate visual outcomes and tectonic stability in each recipient. This method may provide a scalable solution for corneal transplantation in regions with donor shortages.

A single corneoscleral button was obtained from a deceased donor. The anterior lamellar disc was prepared for anterior lamellar keratoplasty. The posterior lamellar disc was used for Descemet's stripping endothelial keratoplasty. The remaining peripheral corneoscleral rim was fashioned into a patch graft. Three patients with distinct corneal pathologies were selected for the procedure. The first patient had a superficial corneal scar. The second patient had pseudophakic bullous keratopathy. The third patient had a perforated corneal ulcer. Each patient received a customized graft based on their clinical needs. Postoperative assessments were conducted to evaluate visual acuity and graft stability.

The first patient achieved a postoperative visual acuity of 20/30. The second patient achieved a visual acuity of 20/60. The third patient showed good tectonic stability with the patch graft. No intraoperative complications were reported in any of the cases. All grafts remained clear and functional at follow-up. The patch graft was the first of its kind used in this customized approach. The anterior lamellar graft provided structural and optical benefits. The posterior lamellar graft improved endothelial function in the second patient.

This case report demonstrates the successful use of a single corneoscleral button for three recipients. The authors propose that customized component corneal transplantation is a viable strategy. The patch graft introduced in this study expands the surgical options available. The approach may help address donor shortages in resource-limited settings. The visual outcomes and graft stability suggest the method is safe and effective. This study provides a practical example of tissue optimization. The authors suggest that this approach could be replicated in similar clinical scenarios. Further validation with larger patient cohorts may be warranted.