Purpose: This paper is intended to report the ultrastructural and biological features of VisionGraft®, a commercially available acellular gamma-irradiated sterile cornea. This is the first known ultrastructural examination of the VisionGraft® with electron microscopy after in-vivo explanation.
Observations: This graft was initially placed for tectonic purposes in a non-responsive culture positive Aspergillus keratitis in a 50 year-old diabetic male, unresponsive to maximal medical therapy. Five months later, a second penetrating keratoplasty with fresh tissue was performed and the Visiongraft® was submitted for histopathologic evaluation. This study reports that there is minimal regrowth of nerves and endothelial cells into the graft, and corneal clarity appears to be preserved even in the absence of endothelium.
Conclusions and Importance: Examination of the acellular cornea showed no significant epithelial regrowth, no nerve regeneration, no infiltration by leukocytes or antigen presenting cells, no significant endothelial regrowth, and yet, surprisingly, no interstitial edema. We offer some hypotheses for these observations based on the histopathologic evaluation and offer some suggestions for future avenues of research.