Corneoscleroplasty with maintenance of the angle in two cases of extensivecorneoscleral disease

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.