Penetrating keratoplasty using collagen crosslinked donor tissue: A case report

PURPOSE: In patients with corneal melt, pretreatment crosslinking (CXL) of donor tissue prior to placement of Boston keratoprosthesis (K-Pro I) decreases graft failure. We report a case of corneal sparing in a phthisical eye following penetrating keratoplasty (PKP) with pretreatment CXL of the donor cornea. OBSERVATIONS: A 69-year-old female with a history of familial aniridia and bilateral K-Pro I placement. Her clinical course was complicated by recurrent corneal melt and hypotony in the left eye, resulting in extraction of the K-Pro I and successive PKP with pretreatment CXL of the donor cornea. She subsequently developed phthisis of the globe with notable retention of corneal structure. At 8 years, she maintains corneal contour without recurrence of keratolysis or extension of phthisis. CONCLUSIONS AND IMPORTANCE: This is the first reported case of corneal sparing in a phthisical eye with a history of PKP, suggesting a protective role of pretreatment CXL of donor tissue against keratolysis and phthisis.