Use Of A Sterile Corneal Stromal Patch Graft (Halo) For The Management Of Impending Corneal Perforation
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR076 | Type: Case Report | DOI: 10.82333/m2ge-0427
Authors: Other Nicholas Johnson* 1 , Mr Tim Rajaratnam 2 , Mr Chrishan Gunasekera 3
1Norwich medical school,University of East Anglia,Norwich,United Kingdom, 2Ophthalmology department,Norfolk and Norwich University Hospital,Norwich,United Kingdom, 3Ophthalmology department,James Paget University Hospital,Great Yarmouth,United Kingdom;Ophthalmology department,Norfolk and Norwich University Hospital,Norwich,United Kingdom
Purpose
To describe the use of a sterile corneal stromal patch graft (Halo) as an emergency tectonic procedure for progressive corneal thinning with impending perforation.
Setting
James Paget University Hospitals NHS Foundation Trust, Gorleston-on-Sea, United Kingdom.
Report of case
A 62-year-old patient with Stickler syndrome presented with a one-week history of pain, redness, and reduced vision in the left eye. Visual acuity was 6/12 in the right eye and hand movements in the left. Intraocular pressure was 17 mmHg (right) and 32 mmHg (left). Slit-lamp examination revealed severe keratitis with a large inferior epithelial defect (approximately 5.1 × 5.0 mm from 5 to 7 o’clock), marked stromal thinning, and inferior anterior chamber exudation obscuring posterior segment view. B-scan ultrasonography suggested a presumed retinal detachment.
Despite intensive medical therapy including hourly topical antibiotics, lubricants, and systemic acetazolamide, the cornea deteriorated rapidly with progressive thinning and focal descemetocele formation, indicating impending perforation.
Emergency surgery was performed the same day. Necrotic tissue was debrided and a sterile corneal stromal patch graft (Halo) was secured as an onlay using 10-0 nylon sutures, with intrastromal antibiotics administered. Post-operatively, oral doxycycline and vitamin C were prescribed. Microbiological investigations were negative.
The graft provided immediate tectonic support, maintained a formed anterior chamber, and prevented perforation. No fibrin developed on the graft surface. Following ocular stabilisation, the patient was referred to a tertiary vitreoretinal centre for management of presumed Stickler syndrome–related retinal detachment.
Conclusion/Take home message
A sterile corneal stromal patch graft (Halo) provides rapid, effective tectonic stabilisation in impending corneal perforation. Its immediate off-the-shelf availability, absence of viable endothelium (eliminating rejection risk), and role as a temporising measure make it particularly valuable when urgent intervention is required or conventional donor tissue is unavailable, allowing preservation of globe integrity and timely referral for definitive posterior segment management.