Early Sterile Keratolysis Complication with Decellularized Porcine Corneal Inlay Implant: A Case Report and Cautionary Tale

Purpose:To describe an early sterile keratolysis associated with a decellularized porcine corneal inlay implant for keratoconus.Methods:This is a case report of a 23-year-old man with keratoconus who underwent lenticular intrastromal keratoplasty in his OD. Within 4 weeks, the patient presented with anterior sterile keratolysis and partial inlay extrusion, leading to surgical inlay removal.Results:After inlay removal, despite aggressive topical treatment including steroid drops, antibiotic ointment, and bandage contact lenses, the patient developed severe anterior scarring and corneal flattening, resulting in decreased visual acuity. Over a period of 4 months, the cornea underwent long-term remodeling, with vision improving to a best-corrected distance visual acuity of 0.1 logarithm of the minimum angle of resolution.Conclusions:The removal of the porcine corneal inlay because of severe keratolysis highlights the potential risks of this procedure. In addition, the spontaneous improvement in visual acuity over 4 months emphasizes the need for adequate healing time before further surgeries, such as keratoplasty.