Abstract
Purpose We report a 2 year follow-up in two patients after corneoscleroplasty.
Method Using lamellar corneoscleral dissection to maintain the drainage angle 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 excised 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 associated with rubeosis iridis. The second eye had had a penetrating keratoplasty 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 visual acuity was improved to a best corrected visual acuity of 0.6. Intraocular pressure in the keratoglobus eye was maintained at 6 mmHg without treatment, whereas the second case required continuing treatment with systemic acetazolamide because of neovascular glaucoma. The anterior chamber angles remained 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 treatment. Phacoemulsification with intraocular lens implantation, which was performed 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 severe destructive corneal disease.
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References
Barraquer J . Total penetrating keratoplasty. Proc R Soc Med 1961;54:1116–21.
Khodadoust AA, Silverstein AM . Studies on the nature of the privilege enjoyed by corneal allografts. Invest Ophthalmol Vis Sci 1972;11:137–48.
Khodadoust AA . The allograft rejection reaction: the leading cause of late failure of clinical allografts. In: Corneal graft failure. Amsterdam: Elsevier, 1973:151–67.
Goulmy E, Pool J, Van Lochem E, Vôlker-Dieben H . The role of human minor histocompatibility antigens in graft failure. Eye 1995;9:180–1.
Suveges I . Sclerokeratoplasty in recurrent pterygium. Germ J Ophthalmol 1992;1:114–16.
Coster DJ . An alternative approach to corneoscleral repair [editorial]. Br J Ophthalmol 1993;77:325.
Reinhard T, Sundmacher R, Heering P . Systemic cyclosporin A in high-risk keratoplasties. Graefes Arch Clin Exp Ophthalmol 1996;234:S115–21.
Sundmacher R, Reinhard T . Central corneolimbal transplantation under systemic cyclosporin A cover for severe limbal stem cell insufficiency. Graefes Arch Clin Exp Ophthalmol 1996;234:S122–5.
Reinhard T, Sundmacher R . Lamellare Horse-Shoe Sklerokeratoplastik und Thermoplastik bei Keratokonus mit peripherer Keratektasie. Klin Monatsbl Augenheilkd 1994;205:305–8.
Kenyon KR, Tseng SC . Limbal autograft transplantation for ocular surface disorders. Ophthalmology 1989;96:709–23.
Tseng SC . Concept and application of limbal stem cells. Eye 1989;3:141–57.
Tseng SC, Tsai RJ . Limbal stem cell transplantation for ocular surface reconstruction: a review. Fortschr Ophthalmol 1991;88:236–12.
Slowik C, Somodi S, Richter A, Guthoff R . Konfokale in vivo Mikroskopie mit 15 mm Sklerokorneoplastik à chaud bei nekrotisierender Keratitis. Klin Monatsbl Augenheilkd 1996;208:246–50.
Taylor DM, Stern AL . Reconstructive keratoplasty in the management of conditions healing to corneal destruction. Ophthalmology 1980;87:892–9.
Cobo M, Ortiz JR, Safran SG . Sclerokeratoplasty with maintenance of the angle. Am J Ophthalmol 1992;113:533–7.
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Presented in part at the 99th meeting of the German Ophthalmological Society, Berlin 1998
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Burk, R., Joussen, A. Corneoscleroplasty with maintenance of the angle in two cases of extensive corneoscleral disease. Eye 14, 196–200 (2000). https://doi.org/10.1038/eye.2000.53
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DOI: https://doi.org/10.1038/eye.2000.53
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