Severe ulcerative keratopathy following implantation of an acellular porcine corneal stromal lenticule in a patient with keratoconus
Berger T, Schlötzer-Schrehardt U, Flockerzi F, Daas L, Flockerzi E, Seitz B (2024)
Publication Type: Journal article
Publication year: 2024
Journal
Article Number: 102145
DOI: 10.1016/j.clae.2024.102145
Abstract
Purpose: To report a case of ulcerative keratopathy following implantation of acellular porcine corneal stroma (APCS) in a patient with keratoconus (KC). Methods: A 58 year-old patient initially presented with an ulcerative keratopathy in the left eye. Previously, several corneal procedures (including radial keratotomy, laser-in-situ keratomileusis, crosslinking) were performed for KC. Eight months ago, an APCS lenticule (Xenia corneal implant, Gebauer Medizintechnik GmbH, Neuhausen, Germany) was implanted into a stromal pocket because of progressive keratectasia. Visual acuity was hand movement. Anterior segment optical coherence tomography showed a space between the APCS lenticule and the host stroma. Excimer laser-assisted penetrating keratoplasty (PKP, 8.0/8.1 mm) was performed in the left eye. The corneal explant was investigated by light and transmission electron microscopy. Results: Best-corrected visual acuity was 20/40 six weeks after PKP. Light microscopy demonstrated a stromal ulceration down to the APCS lenticule. No stromal cells could be found within the APCS lenticule eight months after implantation. The APCS lenticule did not show a green stain of the collagens with Masson-Goldner staining and exhibited a strong Periodic acid-Schiff positive reaction. Electron microscopy of the APCS lenticule revealed cross-linked collagen lamellae without cellular components. Close to the interface, corneal collagen lamellae of the host cornea were disorganized. Few vital keratocytes were present on the surface of the lenticule and appeared to cause mechanical disruption of the host stroma along the lenticule-stroma interface. Conclusion: APCS implantation may lead to severe complications such as ulcerative keratopathy in otherwise uncomplicated KC corneas. In such cases, excimer laser-assisted PKP or Deep Anterior Lamellar Keratoplasty are the methods of choice to restore visual acuity.
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Germany (DE)How to cite
APA:
Berger, T., Schlötzer-Schrehardt, U., Flockerzi, F., Daas, L., Flockerzi, E., & Seitz, B. (2024). Severe ulcerative keratopathy following implantation of an acellular porcine corneal stromal lenticule in a patient with keratoconus. Contact Lens and Anterior Eye. https://dx.doi.org/10.1016/j.clae.2024.102145
MLA:
Berger, Tim, et al. "Severe ulcerative keratopathy following implantation of an acellular porcine corneal stromal lenticule in a patient with keratoconus." Contact Lens and Anterior Eye (2024).
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