Corneoscleral transplantation for extensive infection of the cornea

Purpose: Corneoscleral grafts have been used in the past for anterior segment reconstruction after extensive infection of the cornea. The aim of this study is to present the results of a series of ten consecutive anterior segment reconstruction using corneaoscleral grafts. Materials: We studied ten patients with widespread corneal infection and coagulative necrosis of the cornea. Common features of the surgical technique included a total limbal peritomy in an endeavor to save possible limbal stem cells. To mark the scleral surface and partially trephine this tissue we used trephines of 14-15 mm. After a careful haemostasis we entered the anterior chamber with a diamond knife. The entire cornea was removed and the donor corneoscleral graft was sutured into place onto the scleral ledge using interrupted 8.0 silk or 9.0 nylon sutures. The anterior chamber was filled with viscoelastic material and the conjunctiva was then closet to cover the peripheral part of the graft. Postoperative steroid therapy was methylprednisolone (1gr/kg of body weight) and betametasone 1% eye drops every two hours for 4 weeks and then every four-hour for long term. Results: After a mean time of 15 months after corneoscleral grafts four patients maintain a clear graft. Six patients could be defined as having typical rejection episodes with the corneas becoming opaque. Conclusions: The technique of corneaoscleral transplantation can salvage otherwise end stage eye disease, but the results are poor with respect to maintenance of vision. These patients need careful follow up because of potential complications especially graft rejection and recurrence of disease.