Purpose We report a 2 year follow-up in two patients after corneoscleroplas
ty.
Method Using lamellar corneoscleral dissection to maintain the drainage ang
le and its function, we performed a 14 mm allograft corneoscleroplasty in 2
eyes. For surgical treatment in both cases a 9.5 mm corneal button was exc
ised from the recipient after peritomy and scleral lamellar preparation up
to 14 mm. A 14 mm donor button was inserted and held in place with multiple
Prolene sutures. One eye presented with a large perforating corneal ulcer
after herpetic keratitis in a patient with recurrent rheumatoid uveitis ass
ociated with rubeosis iridis. The second eye had had a penetrating keratopl
asty for keratoconus 30 years previously and presented with decompensating
keratoglobus. Immune suppression was performed with systemic cyclosporin A
and additional steroids when required.
Results Both patients had a clear graft at the last follow-up visit and vis
ual acuity was improved to a best corrected visual acuity of 0.6. Intraocul
ar pressure in the keratoglobus eye was maintained at 6 mmHg without treatm
ent, whereas the second case required continuing treatment with systemic ac
etazolamide because of neovascular glaucoma. The anterior chamber angles re
mained open in both patients. Contact lenses were helpful in the prevention
of epithelial irregularities and defects. Both patients had an episode of
immunological graft reaction which was reversed by immunosuppressive treatm
ent. Phacoemulsification with intraocular lens implantation, which was perf
ormed 2 years after transplantation in the keratoglobus eye, did not affect
the graft clarity or cause rejection episodes.
Conclusion Our results using: corneoscleroplasty have been encouraging in s
evere destructive corneal disease.