A healthy 30-year-old man with a history of prior PKP for hereditary corneal dystrophy performed 12 months before in another institution, presented to our ophthalmological emergency office with an open globe following accidental contusive trauma with a ball, while he was playing football. The double running corneal suture was removed 7 days before the trauma occurrence. At slit-lamp evaluation, complete dehiscence of the wound at the graft-host junction and complete corneal button loss was evident, with partial uveal tissue and vitreous protrusion, and traumatic aphakia. At that time, the donor button was not found.
The patient was provided with comprehensive counselling preoperatively. The patient was then immediately taken to the operating room, but a donor cornea was not available since it was night and the local eye bank was closed. A Wide-Field Landers temporary kerato-prosthesis (Ocular Instruments, Bellevue, WA, USA) was then applied after uveal tissue repositioning and anterior vitrectomy. The patient was examined the day after (shown in Fig. 1a, b), and through the temporary kerato-prosthesis, it was possible to partially explore the retina, which appeared adherent as far as it was possible to visualize. The same day a new donor button was available, and we proceeded to remove the temporary kerato-prosthesis and applied a full-thickness corneal graft of 8.50 mm sutured with 16 detached 10-0 nylon stitches while maintaining a constant 23-gauge pars plana infusion throughout the surgery. Meanwhile, the old corneal graft was found attached to a patient's shoe.