Four patients underwent ab interno Halo® graft implantation. Three presented with corneal perforation secondary to microbial keratitis and one with perforation due to acute hydrops in advanced keratoconus. Globe integrity was achieved in all cases. Three patients retain the Halo® graft in situ without requiring further surgical intervention, including one eye with an underlying chronic retinal detachment with poor visual prognosis. One patient required a two-piece therapeutic mushroom keratoplasty due to persistent severe microbial keratitis.
Use Of Halo® Cornea In Corneal Thinning And Perforations: Temporary Bridge Or Definitive Solution?
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR219 | Type: Free paper | DOI: 10.82333/kch8-pt47
Authors: Mr Saad Mahmud Khan* 1 , Mr Chrishan Gunasekera 2
1Norfolk and Norwich University Hospital,Norwich,United Kingdom, 2Norfolk and Norwich University Hospital,Norwich,United Kingdom;James Paget University Hospital,Great Yarmouth,United Kingdom
Purpose
To evaluate the Halo® corneal graft as an emergency intervention that may function either as a temporary bridging measure or as a definitive repair in patients with corneal thinning and perforation. We report outcomes of our ab interno technique, assessing globe integrity, visual outcomes, and need for subsequent keratoplasty. We also highlight its role in stabilising infection or inflammation prior to definitive surgery, as well as its use in eyes with limited visual potential or in patients unsuitable for general anaesthesia, where optical keratoplasty may not be appropriate.
Setting
Tertiary corneal service in the United Kingdom, managing complex anterior segment pathology. The Halo® corneal graft (VisionGift, Portland, Oregon) is preserved human corneal stroma, stored frozen and sterilised with electron beam irradiation to a sterility assurance level of 10⁻⁶. With a shelf life of up to two years, it is immediately available for emergency use.
Methods
The ab interno technqiue involved suturless placement of the Halo corneal graft over the corneal endothelial surface to provide internal support at the perforation site. All procedures were performed under local anaesthetic. Indications included corneal perforation or impending perforation. Primary outcome measure was restoration of globe integrity. Secondary outcomes included graft retention, visual status, and requirement for further keratoplasty.
Results
Conclusions
The Halo® corneal graft provides effective, immediate tectonic support in patients with corneal thinning and perforation. Its availability, two-year shelf life, and suitability for local anaesthetic surgery allow same-day management of emergencies. It may function as a bridging procedure allowing infection or inflammation to stabilise or serve as definitive repair in eyes with poor visual potential where optical keratoplasty would not be appropriate, preserving fresh donor corneal tissue for patients with greater visual potential. In selected cases, particularly with eccentric perforations, useful vision can be maintained with the use of Halo® cornea.