Corneoscleral transplantation for end stage corneal disease

Abstract

Aim: To describe the prognosis and complications of corneoscleral transplantation in the management of end stage eye disease.

Methods: A case series is presented of 23 patients who have undergone corneoscleral transplantation (> or = 11 mm). Patients were examined for visual acuity, intraocular pressure, recurrence of disease process, epithelialisation of the graft, signs of rejection, and other potential complications.

Results: 14 patients retained their eye, with six maintaining a clear graft. Vision ranged from 6/30 to no perception of light. 13 patients developed glaucoma (range 25-69 mm Hg), with six patients requiring surgical intervention. 12 patients required tarsorrhaphy to promote epithelialisation. Only two grafts resulted in typical rejection.

Conclusions: The technique of corneoscleral 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 of glaucoma, epithelial defects, rejection, and recurrence of disease.

Figure 1

Diagram showing positioning of graft in relation to angle structures. The anterior chamber is entered through the trabecular meshwork.

Figure 2

External photograph of patient with bacterial (Staphylococcus aureus) keratitis in a corneal graft (A) and 2 years after a 12 mm corneoscleral graft (B).

Figure 3

External photograph of patient with fungal keratitis (A) and 7 months after a 12 mm corneoscleral graft, revealing the Molteno tube and 9/0 nylon sutures with exposed knots (B).

Figure 4

External photograph of patient with acanthamoeba keratitis demonstrating multiple corneal biopsy sites (A) and 2.5 years after a 12 mm corneoscleral graft (B).