Oh, the wonders of modern medicine, where we boldly go where no pig part has gone before! Let’s dive into the riveting tale of a 58-year-old patient, who, in a twist of fate, ended up with a piece of acellular porcine corneal stroma (APCS) in their eye. Because, you know, when you’ve already had your cornea zapped, sliced, and crosslinked in every which way for keratoconus (KC), why not throw in a pig cornea for good measure?

So, eight months ago, our intrepid medical team thought, “Hey, why not?” and implanted an APCS lenticule (courtesy of Xenia corneal implant, Gebauer Medizintechnik GmbH, Neuhausen, Germany) into a stromal pocket, because the patient’s keratectasia was getting a bit too avant-garde. Fast forward, and surprise, surprise, the patient presents with ulcerative keratopathy. Who could have seen that coming, aside from, well, anyone?

Visual acuity was at a stellar “hand movement” level, which is just a fancy way of saying, “Can’t see squat but can detect when someone waves a hand in front of their face.” A peek inside the eye with anterior segment optical coherence tomography revealed a cozy little space between the APCS lenticule and the host stroma, because nothing says “successful implantation” like a gap between the implant and the actual eye.

But fear not! Our heroes wielded the mighty excimer laser and performed penetrating keratoplasty (PKP, 8.0/8.1 mm) to save the day. And lo and behold, six weeks later, the patient could see 20/40. A round of applause, please, for going from hand-waving to actually recognizing hand shapes!

Upon closer inspection (because we’re all about that evidence), light microscopy showed that the stromal ulceration had partied all the way down to the APCS lenticule. And, in a shocking turn of events, no stromal cells decided to crash this piggy party even eight months after the implantation. The APCS lenticule, in a bold fashion statement, refused to stain green with Masson-Goldner staining and instead went for a strong Periodic acid-Schiff positive reaction. Electron microscopy revealed that the collagen lamellae were just chilling there, cross-linked without a cellular component in sight, because who needs cells in their cornea, right?

And just when you thought it couldn’t get any more exciting, few vital keratocytes were spotted on the lenticule’s surface, seemingly trying to break free from this porcine prison and causing a bit of a ruckus along the interface.

In conclusion, implanting pig cornea parts into human eyes might just lead to some “severe complications” like ulcerative keratopathy. But hey, if you find yourself in such a predicament, just zap it with a laser and slap on a new cornea. It’s all in a day’s work in the quest to restore visual acuity.