Emergency Use Of Halo® Corneal Grafts In The Management Of Severe Corneal Infections And Perforations

To explore the use of Halo® corneal grafts as an emergency, temporary solution for patients with perforations secondary to microbial keratitis. Through two cases we aim to showcase how these grafts, with their ready availability, can provide a critical solution to preserving and restoring globe integrity in urgent situations.

The surgeries were undertaken at Norfolk and Norwich University Hospital, United Kingdom where complex cases of corneal pathology are managed. The Halo® corneal graft (VisionGift, Portland, Oregon), was used as an emergency, temporizing measure. The Halo® graft is a preserved human corneal tissue that has undergone a patented processing technique to ensure its safety and longevity. Stored frozen then sterilized via electron beam irradiation, these grafts have a shelf life of two years. 

The first case is a 61-year-old male with a history of contact lens use presented with redness, discharge, and vision loss in his right eye. Examination revealed light perception visual acuity, a 5.5mm stromal infiltrate, corneal haze, and a 2mm hypopyon. Corneal scrapes identified Pseudomonas, and aggressive antibiotic therapy was started. Over several days, the corneal defect increased with progressive thinning. Due to the risk of impending perforation, he underwent anterior lamellar keratoplasty using a Halo® corneal graft with Omnigen and Omnilens. One day post-surgery, the cornea stabilized, and at one-week follow-up, vision improved to hand movements with graft integration into host tissue.

The second case was a 78-year-old male who presented with corneal perforation due to microbial keratitis caused by Kocuria rhizophila. He had poor presenting vision of light perception with underlying choroidal effusions. The patient underwent emergency tectonic graft using Halo® cornea, with the addition of Omnigen and Omnilens for additional support. Post- surgery day two, the anterior chamber was formed, and intraocular pressure increased to 23 mmHg. Three months later, intraocular pressure was 13 mmHg, though vision remained light perception. By five months, the anterior chamber remained stable with no leakage and the choroidal effusions had completely resolved.

Halo® corneal grafts provide an effective, readily available solution for managing corneal infections and perforations, especially in emergency settings. These grafts stabilize the cornea, preventing further deterioration, and offer a temporary solution while awaiting definitive treatment if required.