Sutured Halo® Corneal Graft For Corneal Perforation: Outcomes From A United Kingdom Tertiary Centre

To assess the role of the Halo® corneal graft in the emergency management of corneal thinning and perforation, where it may act either as a temporary stabilising measure or as a definitive tectonic repair. Outcomes following the use of ab externo technique were evaluated with particular attention to globe preservation, visual outcomes, and the need for subsequent keratoplasty. We also highlight its role in eyes with limited visual potential where optical keratoplasty may not be justified.

Tertiary corneal service in the United Kingdom providing care for complex anterior segment disease. The Halo® corneal graft (VisionGift, Portland, Oregon) consists of preserved human corneal stroma, stored frozen and sterilised using electron beam irradiation to a sterility assurance level of 10⁻⁶. With a shelf life of up to two years, the graft is readily available for emergency surgical use.

All procedures were undertaken under local anaesthetic. Indications included corneal perforation and impending perforation. The primary outcome measure was restoration and maintenance of globe integrity. Secondary outcomes included graft retention, visual acuity, and the need for further keratoplasty.

Four patients underwent ab externo Halo® graft implantation, which involves suturing the graft over the area of perforation to provide immediate tectonic support and restore globe integrity. Three patients presented with corneal perforation and one patient with impending perforation secondary to microbial keratitis. Successful globe closure was achieved in all cases. Two patients retain the Halo® graft in situ without further intervention. One patient subsequently underwent a two-piece mushroom keratoplasty. One patient died from unrelated systemic co-morbidities and did not require any additional ocular procedures following Halo® repair.

The Halo® corneal graft offers prompt and reliable tectonic support in cases of corneal thinning and perforation. Its immediate availability, extended shelf life, and feasibility under local anaesthetic enable same-day management of corneal emergencies. The graft may serve as a temporary stabilising measure, allowing infection or inflammation to settle, or as a definitive repair in eyes with poor visual prognosis where optical keratoplasty would not be appropriate.