title: Clinicopathologic correlation of explanted AlphaCor artificial cornea after exposure of implant.
abstract: OBJECTIVE
  To describe the clinical presentation and histopathologic findings in a case of explantation of an AlphaCor artificial cornea implant caused by exposure of the skirt.
  
  
  METHODS
  We describe the case report of a 46-year-old man who suffered trauma to the right eye, resulting in 4 failed penetrating keratoplasties (PKPs). Subsequently, an AlphaCor implantation was performed with some visual improvement. Slightly more than 2 years after the implant, skirt exposure occurred, possibly secondary to infectious keratitis in an area of a ruptured bulla, and explantation was performed. Corneal stability was established with repeat corneal transplantation.
  
  
  RESULTS
  Histopathologic evaluation of the surgical specimen revealed chronic nongranulomatous inflammation and fibrosis in the peripheral skirt, indicating that biointegration was maintained. However, peripheral corneal stromal melting led to skirt exposure. Focal calcification, as well as retroprosthetic membrane formation, was also identified.
  
  
  CONCLUSIONS
  The AlphaCor implant is a viable method of treatment for multiple failed PKPs, but it may be associated with unique complications, including corneal stromal melting, focal calcification, and retroprosthetic membrane formation. Infectious keratitis may be a risk factor for corneal stromal melting and needs to be managed aggressively. Explantation of the implant is essential if the skirt is exposed.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Clement C
authors.initials: CC
authors.lastname: Chow
authors.forename: Amol D
authors.initials: AD
authors.lastname: Kulkarni
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Albert
authors.forename: Jason K
authors.initials: JK
authors.lastname: Darlington
authors.forename: David R
authors.initials: DR
authors.lastname: Hardten
mesh_terms: D001187:Artificial Organs / Q000009:adverse effects*; D002114:Calcinosis / Q000175:diagnosis* / Q000209:etiology; D003316:Corneal Diseases / Q000175:diagnosis* / Q000209:etiology; D003319:Corneal Stroma / Q000473:pathology*; D020878:Device Removal; D005355:Fibrosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications