Savastano Alfonso, Crincoli Emanuele, Rizzo Stanislao
Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Ophthalmology Unit, Università Cattolica del Sacro Cuore, Rome, Italy.
Am J Ophthalmol Case Rep. 2023 Jul 13;32:101885. doi: 10.1016/j.ajoc.2023.101885. eCollection 2023 Dec.
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.
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.
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.
严重角膜溶解导致的角膜穿孔是一种非常危险的、威胁视力的情况，由于存在眼内炎和严重低眼压的高风险，需要立即进行处理。对于穿孔的角膜移植片，通常会推迟再次移植，以避免炎症对新移植片产生不利影响。我们描述了首例使用TutoPatch移植片紧急替换急性感染性全角膜溶解时的板层移植片穿孔的病例。
一名42岁男性患者因左眼疼痛就诊于急诊科，左眼发红且畏光。他5年前因晚期圆锥角膜接受了双侧深板层角膜移植术（DALK），在过去8个月内左眼反复出现角膜溃疡。临床检查发现左眼急性感染性角膜溶解导致角膜穿孔，累及整个移植片表面。将感染的移植片连同穿孔的感染残留Descemet膜一并切除，用10.0尼龙线将双层TutoPatch覆盖物缝合至宿主边缘。覆盖物保留三周，三周后患者顺利接受再次移植，未出现并发症。
TutoPatch覆盖物可安全用作易于保存的紧急材料，作为大型急性感染性角膜溶解时再次移植的临时桥梁。
