Staged penetrating sclerokeratoplasty and penetrating keratoplasty for management of advanced acquired anterior staphyloma

Abstract

Herein we describe a staged surgical technique consisting of penetrating sclerokeratoplasty (PSKP) followed by penetrating keratoplasty (PKP) and present its clinical course and complications over two years of follow-up. A 23-year-old man presented with cosmetically unacceptable protrusion of the globe corresponding to the cornea and sclera. PSKP was performed transplanting a full-thickness beveled 13 mm corneoscleral tectonic graft. Hypotony developed subsequently and was successfully managed medically, however corneal graft failure occurred. After 15 months, a 7.5 mm PKP was performed for optical reasons, which subsequently remained clear with a healthy epithelium. In this particular case, cosmetic, tectonic, therapeutic, and optical requirements were met. PSKP is a surgical procedure which entails a high rate of complications but may be the only alternative when the main goal of intervention is restoration of the globe in complicated cases such as our patient.

Keywords: Anterior Staphyloma; Corneal Ulcer; Penetrating Keratoplasty; Sclerokeratoplasty.

Figure 1

Acquired anterior staphyloma preventing eyelid closure.

Figure 2

Histopathology of the excised specimen, the corneal epithelium is transformed into epidermis; loss of Bowman’s layer is noted and neovascularization is present in the anterior stroma (Hematoxylin-Eosin, ×40).

Figure 3

Anterior segment appearance one day after sclerokeratoplasty, note the formed anterior chamber.

Figure 4

After penetrating keratoplasty the graft remained clear.

Figure 5

Appearance of the patient, pre- and postoperatively: (A) before penetrating sclerokeratoplasty (PSKP), (B) post-PSKP, (C) after late graft failure, and (D) final result with a cosmetic contact lens.