Ab Interno Approach to Sealing Corneal Perforations Using Off-the-Shelf Human Cornea

Corneal perforations necessitate prompt surgical intervention to restore globe integrity and mitigate the risk of irreversible vision loss. Larger corneal perforations often require more complex surgical strategies, including tectonic patch grafting or penetrating keratoplasty. However, limited availability of donor tissue presents significant challenges in meeting urgency of these cases. We describe an ab interno technique approach for corneal perforation repair, using off-the-shelf human cornea as an alternative viable surgical treatment.

The surgery was performed at a tertiary center in the United Kingdom, where Halo (VisionGift, Portland, OR) cornea, made from preserved human corneal tissue, was used for perforation repair. The tissue meets Food and Drug Administration and United Kingdom regulatory standards.

An 89-year-old woman presented with a painful, red left eye associated with significant vision loss. She had a complex ocular history, including herpes zoster ophthalmicus keratitis. On examination, the left eye visual acuity was reduced to hand motion with an inferior corneal perforation. Surgical management involved placement of the Halo cornea disc internally over the defect with gas tamponade. At 1 week, the patient's left eye vision had improved to 6/24, with intraocular pressure of 10 mm Hg. Nine months postsurgery, the left eye's visual acuity improved to 6/9, with no graft detachment, inflammation, or vascularization observed.

This case highlights the successful use of a Halo cornea graft for the management of a large peripheral corneal perforation in a patient with complex ocular pathology. This technique would be of particular interest to ophthalmologists who manage corneal perforations.