Tectonic Keratoplasty Using Acellular Preserved Human Cornea for the Inciting Eye in Sympathetic Ophthalmia

Purpose: We report a case of sympathetic ophthalmia in which the inciting eye was treated with a tectonic keratoplasty using acellular preserved human cornea.Case summary: A 68-year-old man whose left eye was injured by a nail visited our institute complaining of a recent decrease in bilateral vision. The best corrected visual acuity was 0.32 for the right eye and 0.16 for the left. On slit-lamp examination, a superior peripheral corneal perforation with no wound leakage due to iris plugging was seen in the left eye (i.e., the inciting eye). The right eye (i.e., the sympathizing eye) had mutton-fat keratic precipitates and copious fibrinoid strands in the anterior chamber. Bilateral exudative retinal detachment with choroidal folds was prominent in both eyes. The next day, the necrotic iris lump was removed from the inciting eye and adhesiolysis of the iris and tectonic keratoplasty using acellular preserved human cornea were performed. Systemic steroid was started immediately postoperatively. The exudative retinal detachment improved in both eyes and cataract surgery was undertaken for the inciting eye 4 months later. Twenty-one months after the initial visit, the uncorrected visual acuity was 1.0 in the inciting eye, and both eyes had a sunset glow fundus appearance, without optic atrophy or recurrent chorioretinitis.Conclusions: Tectonic keratoplasty using acellular preserved human cornea with anti-inflammatory treatment may be a favorable therapeutic option for the inciting eye with peripheral corneal perforation in sympathetic ophthalmia.