Ethanol-Preserved Corneoscleral Tissue for Emergency Tectonic Keratoplasty in Corneal Perforations: A Retrospective...

There is a global shortage of donor tissue for corneal transplantation. Long-term stored ethanol-preserved corneoscleral tissue may help address this shortage, particularly in emergency cases of corneal perforation.

This retrospective study analyzed tectonic keratoplasties for perforated corneal ulcers performed between January 2018 and December 2022. A total of 20 surgeries in 14 patients (6 female, 8 male) using ethanol-conserved corneoscleral tissue were included. Surgical, postoperative, and follow-up data were analyzed until December 2024, including graft storage duration, epithelialization, graft survival, complications, and best-corrected visual acuity. Outcomes were considered favorable if only planned surgery or no further surgery was required, and unfavorable if additional emergency intervention was necessary.

The mean patient age was 83.5 (interquartile range 69.2-87.8) years (range 40.2-89.8). The cause of corneal perforation included immune-mediated corneal ulcers n = 8 (40%), neurotrophic corneal ulcers n = 7 (35%), herpetic corneal ulcerations n = 4 (20%), and fungal keratitis n = 1 (5%). The median graft size was 4.0 mm, with a median storage duration of 71.5 days (range 4-346). Graft survival resulted to 23.2 ± 17.4 months. A favorable outcome was achieved in 12 cases (60%). Epithelial closure was observed in all cases within 15 days. Best-corrected visual acuity improved from 1.7 ± 0.8 logMAR to 1.1 ± 0.7 logMAR.

Ethanol-preserved corneoscleral tissue is safe and feasible for emergency tectonic keratoplasty. Its extended storage capacity may aid in the current global shortage of donor corneas.