Early Sterile Keratolysis Complication With Decellularized Porcine Corneal Inlay Implant: A Case Report and Cautionary Tale

Alfredo Borgia; Matteo Airaldi; Neil Lagali; Mohammad Ahmad; Amina Riaz; Stephen Kaye; Vito Romano

doi:10.1097/ICO.0000000000003764

Early Sterile Keratolysis Complication With Decellularized Porcine Corneal Inlay Implant: A Case Report and Cautionary Tale

Cornea. 2024 Nov 26. doi: 10.1097/ICO.0000000000003764. Online ahead of print.

Authors

Alfredo Borgia^{1

2}, Matteo Airaldi^{1

3

2}, Neil Lagali^{4

5}, Mohammad Ahmad¹, Amina Riaz¹, Stephen Kaye^{1

2}, Vito Romano^{1

2

6}

Affiliations

¹ St. Paul's Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool, United Kingdom.
² Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; and.
³ Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
⁴ Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.
⁵ Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.
⁶ Ophthalmology Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy.

PMID: 39588932
DOI: 10.1097/ICO.0000000000003764

Abstract

Purpose: To describe an early sterile keratolysis associated with a decellularized porcine corneal inlay implant for keratoconus.

Methods: This is a case report of a 23-year-old man with keratoconus who underwent lenticular intrastromal keratoplasty in his OD. Within 4 weeks, the patient presented with anterior sterile keratolysis and partial inlay extrusion, leading to surgical inlay removal.

Results: After inlay removal, despite aggressive topical treatment including steroid drops, antibiotic ointment, and bandage contact lenses, the patient developed severe anterior scarring and corneal flattening, resulting in decreased visual acuity. Over a period of 4 months, the cornea underwent long-term remodeling, with vision improving to a best-corrected distance visual acuity of 0.1 logarithm of the minimum angle of resolution.

Conclusions: The removal of the porcine corneal inlay because of severe keratolysis highlights the potential risks of this procedure. In addition, the spontaneous improvement in visual acuity over 4 months emphasizes the need for adequate healing time before further surgeries, such as keratoplasty.