# Restoring the Ocular Integrity of Perforated Corneal Ulcer Using Living Surgical Donor Tissues Derived From Keratoplasty in the COVID-19 Pandemic

## TL;DR

This paper presents a novel surgical approach using preserved corneal tissues from previous surgeries to treat severe corneal ulcers during the COVID-19 pandemic.

## Contribution

The study introduces the use of host corneal buttons from optical penetrating keratoplasties as a solution during tissue shortages.

## Key findings

- Using preserved host corneal tissues achieved good anatomical integrity in two patients with perforated ulcers.
- Optical penetrating keratoplasty was necessary for final visual rehabilitation after initial therapeutic surgery.
- The method proved safe and effective during a shortage of standard corneal tissues.

## Abstract

The coronavirus disease 2019 (COVID-19) caused an unprecedented crisis for corneal surgeons who were forced to strategize for an acute shortage of tissues. Here, we report the initial clinical outcomes of utilizing host corneal buttons derived from optical penetrating keratoplasties of pseudophakic bullous keratoplasty (PBK) patients. Two patients presented to our department with a perforated fungal corneal ulcer in one eye during the COVID-19 pandemic. One eye of each of the patients was operated on with non-vascularized host cut tissues preserved in glycerin. The tissues were secured using 10-0 nylon sutures. Good anatomical integrity was achieved in both eyes. An optical penetrating keratoplasty (PK) was done in both eyes after one year for visual rehabilitation, with a final visual acuity of 20/120 and 20/80, respectively, at six months. In conclusion, therapeutic PK using host tissues obtained from the recipients of optical PK is a safe and effective option to restore ocular integrity during a shortage of fresh or glycerol-preserved corneas. However, optical PK is required for the final visual rehabilitation.