Corneoscleral Graft Research Articles

Outcomes of sclerokeratoplasty in severe ocular surface disease

Sclerocorneal grafts are procedures considered in cases with extensive corneal and scleral tissue destruction. The study aims to describe sclerokeratoplasty outcomes in severely diseased eyes. We performed a retrospective review of clinical records. Demographic characteristics, medical history, surgical indications, aetiology of perforation, visual outcomes, complications associated with the surgical procedure, and ocular integrity at the end of the follow-up were obtained. Wilcoxon-signed rank tests and Mann-Whitney tests were used to compare complications between groups and outcomes at final follow-up. Survival analysis was performed to analyse vision preservation and global integrity and presented in Kaplan-Meier curves. 40 eyes from 40 patients with a mean age of 48.83 ± 18.85 years and a mean follow-up of 21.13 ± 33.92 months were included in the study. Median corrected visual acuity before and after the procedure remained at 2.8 logMAR. Twenty-seven eyes presented complications. The most common complications were a persistent epithelial defect in 11, hypertension in 10, and perforation in 8 eyes. More than half of the eyes (67.5%) presented with either one or more of all complications after corneoscleral graft. No significant differences were found regarding age, gender, or DM history. Concerning perforation, a significant difference was found between infectious and non-infectious only in the presentation of ocular hypertension (p = 0.048). Vision was preserved in 72.5% of the eyes, with a median survival probability of 4.12 years. Preservation of the ocular integrity was achieved in 85% of the eyes, with a median survival probability of 12 years. Sclerokeratoplasty despite being challenging and technically demanding followed by defiant complications, in some situations such as infectious keratitis and autoimmune diseases, is likely a procedure that salvages the eye and preserves vision.

Modified tectonic corneoscleral graft technique for treating devastating corneoscleral infections

BackgroundThis study aims to evaluate the clinical outcomes and efficacy of a modified tectonic corneoscleral graft (TCG) in patients suffering from devastating corneoscleral infections.MethodsThirty-eight eyes from 38 patients who underwent the modified TCG were included in this study. The outcomes measured were recurrence rates, best-corrected visual acuity (BCVA), ocular surface stability, postoperative complications, and graft survival.ResultsAmong the 38 patients, 23 had fungal infections, 9 had bacterial infections and 6 had Pythium insidiosum infections. At the final follow-up, with an average duration of 25.1 ± 8.6 months, the rate of monocular blindness decreased from 100 to 58%. Significant improvements in LogMAR BCVA were observed from preoperative to postoperative measurements (P < 0.001). Thirty-two eyes (84.2%) maintained a stable ocular surface. The survival rate of ocular surface stability was 84.2%±5.9% at one year and 57.7%±9.7% at three years post-surgery. Twenty eyes (52.6%) retained a clear graft, with a survival rate for graft clarity was 81.6%±6.3% at one year and 36.0%±10.8% at three years post-surgery. The incidence of immune rejection was 36.8%. Corneal epithelial defects were observed in ten patients, and choroidal detachment occurred in four patients. No cases of elevated intraocular pressure were detected.ConclusionsThe modified TCG is effective in eradicating infections, preserving the eyeball, and maintaining useful vision in cases of devastating corneoscleral infections. Regular use of tacrolimus, timely administration of glucocorticoids, and good patient compliance can help mitigate postoperative challenges.

Patch Transplant in Corneal Perforations: Time, Method, and Cause.

We present demographic data and clinical features of corneal perforations repaired with patch grafts prepared from residual donor corneal rims. For this retrospective study, we evaluated patients who underwent corneal perforation repair with corneal or corneoscleral patch grafts. We recorded demographic data, as well as perforation cause, examination notes, tissue type-size used, follow-up time, and additional surgeries. Anterior segment photographs were also evaluated. Transplanted tissues were prepared from residual donor corneas used in penetrating keratoplasty and were manually adjusted to the precise size of the wound. Fifteen patients were enrolled in the study. Mean age of the patients was 64.9 ± 19.7 years (range, 15-81 years) with a female-to-male ratio of 0.85. The causes of perforation were grouped as inflammation, infection, and trauma. The main indications were inflammation (n = 7; 46.7%) and infection (n = 6; 40%), followed by trauma (n = 2; 13.3%). All patients demonstrated preservation of globe integrity during the follow-up time; however, 1 patient's eye required regrafting with limbal conjunctival excision due to melting and leakage. Three eyes required permanent tarsorrhaphy to control progressive exposure keratopathy, and 2 eyes underwent penetrating keratoplasty to cure scar-related corneal opacity. Patch grafts are effective surgical interventions to assure and maintain globe integrity in corneal perforations. The main advantage seems to be that patch grafting allows special preparations for wound architecture. Moreover, in clinics performing keratoplasty, these patch tissues are readily available.

The Use of Corneoscleral Grafts to Maintain Tectonic Stability in Severe Keratolysis.

Severe corneal ulcerations, causing major keratolysis with large perforation of the cornea or extending to the limbal region, are an ophthalmic emergency. In these cases, a larger corneoscleral graft can be transplanted to restore tectonic integrity, alleviate pain, save vision, and prevent loss of the eye. Chart review of 34 patients with a corneoscleral graft ≥9.5 mm was conducted. Primary endpoints of the study were tectonic stability defined as no need for another keratoplasty or enucleation. In addition, visual acuity, postoperative complications, and secondary procedures were analyzed. In total, 12 patients (35%) were female. The mean age at transplantation was 65 ± 19 years. The underlying disease was a perforated infectious corneal ulcer in 30 cases (88%). Mean follow up was 675 ± 789 days. Tectonic stability at the end of the follow-up was maintained with a probability of 56% in a Kaplan-Meier analysis. Another penetrating keratoplasty was necessary in six cases (17%) and enucleation in five cases (15%). A corneoscleral transplant remains a viable treatment option to prevent enucleation in severe keratolysis. In our study, this was possible in about half of the cases. Postoperative complications, secondary surgeries, and markedly reduced visual acuity put the advantages into perspective.

Indications, techniques, and graft survival of mini and corneo-scleral tectonic keratoplasties: A retrospective single-center case series.

Tectonic keratoplasties (TK) are used to treat corneal and scleral perforations and to prevent the loss of the eye. In this study, we retrospectively analyzed indications, surgical procedures, and outcomes of eccentric mini and corneo-scleral tectonic keratoplasties with respect to anatomical survival and clear graft survival rates to identify risk factors for graft failure. This retrospective study includes 33 eccentric mini (graft diameter <6 mm) and/or corneo-scleral TK of 32 consecutive patients of a total of 41 TK carried out between 2005 and 2020 in the Eye Center, University of Freiburg, Germany, making up 0.7% of all keratoplasties performed during this period (n = 5557). Patient and graft specific data were extracted from medical files. Anatomical survival-defined as achieving integrity of the globe without further surgical interventions-and clear graft survival-defined as persisting graft clarity-were estimated using the Kaplan-Meier method. We also fitted Cox proportional hazard models to account for factors influencing anatomical and clear graft survival. Median duration of anatomical success was 72.5 months (95% confidence interval (CI) 18.1-infinite (inf.)) and median duration of clear graft survival was 29.6 months (95% CI 12.5-Inf.). The 1-year survival rate for anatomical survival was 67.6% (95% CI 52.2% - 87.6%) and for clear graft survival 66.4% (95% CI 50.5%- 87.1%). No enucleation was necessary during this time-period. Non-inflammatory primary causes (n = 14) presented a trend towards better anatomical survival rates (median remained above 0.75 during follow-up) compared to inflammatory primary causes (n = 19, median 18.1 months (95% CI 2.8 - inf.)) and longer clear graft survival (median 29.6 months (95% CI 12.5 - inf.) versus 13.1 months (95% CI 3.2 - inf.)). Corneo-scleral grafts (n = 18) compared to corneal grafts (n = 15) showed a trend towards better anatomical survival (more than 50% of eyes did not fail during follow-up period (95% CI 21.9-Inf. months) versus 18.1 months (95% CI 2.4-Inf.)) and clear graft survival (median 29.6 months (95% CI 12.6-Inf.) versus 6.2 months (95% CI 2.8-Inf.)). Old age (n = 11, 75.2 - 90.1 years) compared to young age (n = 11, 6.2 - 60.2 years) was the only hazard ratio (hazard ratio 0.04 (95% CI 0.002-0.8)) that reached the level of significance (p = 0.03). Eccentric TK is helpful in the successful treatment of a variety of severe eye diseases. Patients at young age, with pre-existing inflammatory conditions or corneal TK are at higher risk for anatomical failure as well as clear graft failure and therefore need to be monitored closely.

Long-term outcome of limbal-sparing lamellar keratoplasty in keratoglobus: A retrospective case series

We report six eyes of five patients with keratoglobus who underwent limbal-sparing lamellar keratoplasty (LSLK) with 7 years of follow-up. In two patients’ three eyes, it was congenital and the rest had acquired keratoglobus from pellucid marginal degeneration combined with keratoconus. In LSLK, the peripheral corneal epithelium is dissected to include the stem cells and reflected along with conjunctival peritomy. The host cornea is de-epithelialized, stromal irregularities dissected, and then a corneoscleral graft denuded of Descemet’s membrane is anchored to a scleral ledge fashioned. Postoperatively, all received adequate tectonic support, and except for one posttrauma eye, the rest improved visually.

Bilateral peripheral ulcerative keratitis

A 13-year-old girl presenting with mucopurulent conjunctivitis (left &gt; right) was diagnosed with Behçet's disease. Intraoperatively, the left eye had 360° culture-negative marginal corneal ulcer with scleral necrosis, managed with a scleral patch graft. Postoperatively, the right eye also developed a peripheral corneal lesion that resolved with immunosuppressants along with the skin lesions. Subsequently, wound gaping and uveal prolapse were noted in the left eye and was managed with a lamellar corneal graft and later with a corneoscleral patch graft. Following this, the patient improved very well in terms of visual acuity. Peripheral ulcerative keratitis can be a clinical presentation in pediatric Behçet's disease despite the unusual occurrence. Hence, any pediatric case with peripheral ulcerative keratitis should be thoroughly investigated for Behçet's disease, for which immunosuppressants may prove to be beneficial.

Block excision and tectonic corneoscleral grafting for epithelial implantation cyst after intraocular contact lens implantation.

Block excision and tectonic corneoscleral grafting for epithelial implantation cyst after intraocular contact lens implantation.

Novel technique of tetra trephination for elliptical-shaped tectonic patch grafts in peripheral sterile keratolysis.

To describe a novel technique of tectonic patch grafts for elliptical-shaped peripheral sterile keratolysis with iris prolapse. We performed a full thickness corneo-scleral patch graft in five eyes of five patients with elliptical-shaped peripheral sterile keratolysis with perforation and iris tissue prolapse. In this technique, four disposable trephines with predetermined diameter were employed to fashion both the host and the donor without any free-hand dissection. An intact anatomical integrity of the globe without the need for any repeat tectonic measures was considered as a successful outcome. The mean age was 34.2 ± 10.2 years (18-45). The mean total surgical time and donor preparation time was 94.4 ± 7.12 min and 7.6 ± 1.14 min, respectively. The intraoperative course was uneventful in all cases and all eyes had a well-maintained corneal integrity till 6 months follow up. We describe a simple, reproducible, and time-saving technique of performing elliptical shaped corneoscleral patch grafts for peripheral corneal perforations with iris prolapse.

Use of Corneas from Hepatitis B Positive Donors for Corneal Transplantation

Background: In most of the world, corneas from hepatitis B surface antigen (HBsAg)-positive donors have been considered unsuitable for transplantation because of assumed risk of disease transmission. Methods: In Taiwan, an HBV endemic area, corneas from HBsAg-positive donors can be allocated to recipients who are seropositive for HBsAg or antibody against HBsAg (anti-HBs). Between January, 2015 and December, 2019, we evaluated HBV DNA in serum and corneo-scleral rims retrieved from HBsAg-positive and HBsAg-negative donors. We assessed donor serum HBsAg, anti-HBs, hepatitis B core antibody (anti-HBc) and HBV DNA to predict the presence of their corneo-scleral HBV DNA. We conducted a look-back study of recipients transplanted with corneo-scleral HBV DNA-positive donor grafts. Their HBV serological profiles were examined to identify possible post-transplantation hepatitis B transmission. Findings: Forty-five and 125 corneal grafts from 28 HBsAg-positive and 85 HBsAg-negative donors, respectively, were included. The donor corneo-scleral rim HBV DNA-positive rate was significantly greater in HBsAg-positive donor grafts (80·0%) compared to that of the HBsAg-negative grafts (6·4%, [ P <0·001]). Eight grafts harvested from HBsAg-negative, but anti-HBc-positive donors carried HBV DNA. The donor anti-HBc-positivity provides the highest sensitivity (1·00) and negative predictive value (1·00) in predicting the existence of corneo-scleral HBV DNA. A total 28 out of 40 (70·0%) recipients transplanted with HBV DNA-positive grafts participated in the look-back study, and none developed clinical disease or seroconversion to indicate post-transplantation hepatitis B. InterpretationHBV DNA was detected on corneas from HBsAg-positive and HBsAg-negative, anti-HBc-positive donors. However, the risk of post-transplantation hepatitis B is small in an endemic area. Allocation of corneas from HBsAg-positive or anti-HBc-positive donors to HBsAg-positive or anti-HBs-positive recipients may be a safe and effective way to expand corneal donor pools in hepatitis B endemic areas of the world. Funding: Ministry of Health and Welfare, Taiwan (TORSC-1031006, 1041130, 1051220, 1061030, 1071030) Declaration of Interest: All of the authors have no competing interests. Ethical Approval: The corneo-scleral HBV DNA study was approved by National Taiwan University Hospital Research Ethics Committee (NTUH REC) (No. 201702010RINC).Donor pre-mortem serologies of HBsAg, anti-HBs, and anti-HBc, as well as donor corneal endothelial cell densities were retrieved from the electronic databases of the National Eye Bank of Taiwan.

Glycerin-preserved Human-donor Corneoscleral Patch Grafts for Glaucoma Drainage Devices.

Glycerin-preserved, human-donor, corneoscleral patch grafts are effective and safe for glaucoma drainage device (GDD) implantation, and they are comparable to previously reported materials. It can be preserved with the sterile technique for up to 12 months. To evaluate the efficacy and safety of glycerin-preserved human donor corneoscleral tissue as the patch graft for GDD implantation. This was a retrospective noncomparative study from the medical records of 102 eyes from 102 glaucoma patients who underwent GDD implantation by or under supervision of a single surgeon (N.K.) at the Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand between January 2006 and December 2016. The glycerin-preserved human-donor corneoscleral tissue was used as the patch graft to cover the tube portion of GDD over the sclera. The primary outcome measure was the occurrence of patch graft-related complications. There were 64 males and 38 females with the mean age of 52.8±18.5 years. The underlying diseases included failed filtration surgery with primary open-angle glaucoma 32 eyes and primary angle-closure glaucoma 15 eyes, congenital glaucoma 3 eyes and secondary glaucoma 52 eyes. The mean of ocular surgeries before GDD implantation was 2.3±1.1. Patch graft-related complications included tube exposure in 4 eyes (3.9%) and wound leakage in 4 eyes (3.9%). Eyes with tube exposure underwent regrafting 3 eyes and tube reposition 1 eye. Eyes with wound leaking resolved spontaneously 2 eyes and underwent conjunctival resuturing 2 eyes. The 5-year survival rate of the corneoscleral graft was 95.7%. There was no recurrence of graft-related complications after surgical procedure to correct the complications. Postoperatively, the mean of intraocular pressure and antiglaucoma medications decreased significantly from 27.4±9.8 mm Hg and 3.8±0.93 to 13.8±6.4 mm Hg (P<0.001) and 1.6±1.5 (P<0.001) at the last visit, respectively. The mean follow-up time was 59.9 months (range, 1 to 144.7 mo). The glycerin-preserved human-donor corneoscleral tissue using as the patch graft was a safe alternative for GDD tube coverage. The patch graft-related complications was comparable to other materials.

Treatment of Limbal Melanocytoma with Full Excision and a Fresh Homologous Corneoscleral Graft in a Dog

Background: Limbal melanoma has been diagnosed in dogs and due to progression may cause vision loss and eyeball removal. Definitive diagnosis is made through histopathological examination. Therapeutic options include full thickness resection and repair by homologous corneal tissue, synthetic graft material, and enucleation. In this report, we describe a case of limbal melanocitoma in a dog that has been treated successfully with fresh homologous corneoscleral graft.Case: A 5-year-old female Labrador was referred to the Ophthalmology Veterinary Section of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil, with a history of a pigmented mass located on the left eye. Ophthalmic examination revealed a pigmented mass located at the left temporal limbus with corneal involvement. Surgical excision followed by reconstruction using fresh homologous corneoscleral was recommended. The patient was premedicated with acepromazine (0.05 mg/kg, IM) and meperidine (20 mg/kg, IM). Anaesthesia was induced with propofol (10 mg/kg, IV) and maintained with isoflurane. Atracurium (0.2 mg/kg, IV) was administered to maintain a central eye position. The mass and a free margin were removed by full-thickness corneoscleral resection. A corneoscleral graft was harvested from a dogthat had been euthanised for reasons unrelated to this study and sutured with 9-0 polyglactin 910 using a simple interrupted pattern. The mass was immediately fixed in 10% neutral buffered formalin and submitted for histological sectioning and routine staining. Based on the histopathological analysis it was confirmed limbal melanocytoma. Postoperative treatment consisted of topical administration of 0.3% flurbiprofen every 6 h for 15 days, and a combination of topical ciprofloxacin/dexamethasone eye drops every 6 h for 30 days. Systemic carprofen (4 mg/kg per day, VO) was prescribed for 10 days. Topical tropicamide was used twice daily for 1 week. Cyclosporin 0.2% eye drops were applied twice daily for 2 months. Examination of the left eye two months after surgery revealed decreased corneal vascularization, and the results of pupillary light response and vision testing were normal. The values of intraocular pressure remained normal in all postoperativeevaluations. The patient was followed for 36 months postoperatively, during which time there was no recurrence.Discussion: Limbal melanomas are the most common ocular melanomas in dogs. Most of them develop slowly and are located closely to the superior limbus. The tumors tend to grow more rapidly in younger dogs and more slowly in older dogs. Labrador Retrievers and German shepherds appear to be affected more frequently than other breeds. The present case involved a 5-year-old Labrador breed. The clinical presentation included a pigmented limbal mass extending intothe adjacent cornea, sclera and conjunctival tissue. A tissue biopsy is necessary to confirm the diagnosis. In the present case, the diagnosis of limbal melanocytoma was based on clinical signs and confirmed by histopathological examination. The choice of treatment is influenced by the tumour size and location, availability of equipment and materials, clinician expertise and the cost of treatment. Some techniques for removing the mass and repairing the resultant corneoscleral defect has been described. In the present case, due to the location and size of the mass and the absence of intraocular invasion, surgical removal including a margin of normal tissue was performed. With this surgical procedure, the intention was to preserve the eyeball and maintain vision. In this case, surgical excision of a limbal melanocytoma combined with homologous corneoscleral graft was effective for repairing a full-thickness corneoscleral defect and preserving ocular function.

Lamellar keratoplasty with corneoscleral graft for limbal dermoids.

To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients (mean age: 13.0y) who had undergone limbal dermoid excision with lamellar corneoscleral graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm (6.0-12.0 mm). Mean visual acuities (in logMAR units) before and after surgery were 1.8 and 1.7, respectively (P=0.29). Spherical equivalents were 1.3 diopter (D) before surgery and 0.7 D after surgery (P=0.40). The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively (P=0.17). Vector analysis revealed a mild change in astigmatism with a mean "d" of 3.2 (0.56-6.89). No intra- or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.

Partial regression of large anterior scleral staphyloma secondary to rhinosporidiosis after corneoscleral graft - a case report

BackgroundRhinosporidiosis is a rare chronic infection of the mucous membranes caused by the Rhinosporidium seeberi. Approximately 15% of cases of rhinosporidiosis are ocular, occurring mainly in the tarsal conjunctiva. There are only 11 cases of scleral melt with staphyloma formation associated with bulbar conjuctival oculosporidiosis and none of them was associated with partial regression of the scleral ectasia after a corneoscleral tectonic graft.Case presentationa 13-year-old girl with a progressively increasing black mass in the upper nasal part above the cornea of the left eye. The biomicroscopy revealed an oval, bluish mass measuring 10x10x5 mm with congestion of the overlying conjunctiva. Conjunctival biopsy showed sporoblasts of Rinosporidium seeberi. Treatment was conducted by conjunctival resection and tectonic corneoscleral graft (13x13mm) over the staphyloma. Within 1 year of follow-up the patient presented a partial staphyloma reduction, 9x9x2.5 mm, and the patch detached from the lesion. A novel surgical approach was done reducing the corneal patch and no recurrence was seen after 9 months.ConclusionsThis case is one of the largest anterior scleral staphylomas secondary to rhinosporidiosis described in the literature. Scleral anterior staphyloma partial regression is an unusual outcome after a tectonic corneoscleral graft. Infection resolution and graft covering of thinned area contributed to scleral reepithelization.

Sclerocorneal graft and sequential removal of melted cornea after severe corneal burn with perforation.

Corneal burn grade IV usually leads to blindness. Several different surgical techniques remain challenging owing to the extensive tissue damage. Here, we introduce a novel technique with a 15 mm corneoscleral and limbal homologous graft combined with sequential autologous corneal removal ab interno, with a vitrectomy probe to save the anterior chamber angle. In vivo anatomy with optical coherence tomography is the surgical key. A large 15 mm sclerocorneal graft is sutured on top of the remainder of the destroyed cornea and sclera after removal of the epithelium and conjunctiva, with anterior synechiolysis if necessary, peripheral iridectomy and conjunctivoplasty. The recipient central corneal stroma is not removed, primarily to protect the anterior chamber angle. After three weeks, the collagenolytic central recipient corneal stroma can be removed with a small 23 g vitrectomy probe, respecting the lens and scleral spur. The corneoscleral graft remains clear under systemic and local immunosuppression. Intraocular pressure is well controlled because the anterior chamber angle is respected. Recurrent corneal erosions need close follow-up. Therapeutic soft contact lenses can support topical therapy. In cases of sclercorneal graft decompensation or rejection after 3-5 years, a new sclerocorneal graft (with limbal donation) seems to be superior to perforating keratoplasty without limbal stem cell transplantation. Repeated sclerocorneal grafts after severe corneal burn with limbal transplantation and maintenance of the complete anterior angle structure are a successful option for preventing blindness and achieving good visual acuity. Clin. Anat. 31:39-42, 2018. © 2017 Wiley Periodicals, Inc.

Differences in Surgical Management of Corneal Perforations, Measured over Six Years

Purpose. To report the surgical approach, anatomical and functional results, and complications in the group of patients with corneal perforation. Materials and Methods. 247 eyes with corneal perforation were operated on between January 2010 and July 2016. The three surgical procedures, dependent on size and location of perforation, were performed: full-sized penetrating keratoplasty, corneoscleral patch graft, and anterior lamellar keratoplasty. The eyes underwent the minimum 6-month follow-up visit. Results. Between January 2010 and July 2016, 247 surgeries were performed: 116 penetrating keratoplasties, 117 corneoscleral patch grafts, and 14 anterior lamellar keratoplasties. More than one procedure was necessary in 32 eyes. Final improvement of the visual acuity, within a gain of 2 or more lines with the Snellen test, was achieved in 56 operated eyes. To achieve better final visual acuity, 75 eyes required successive surgical treatment. Complications of the surgery comprised persistent epithelial defect, glaucoma or ocular hypertension, corneal oedema, graft melting, loose corneal sutures, reinfection, anterior synechiae and fibrinoid membranes, and endophthalmitis. In 26 eyes, the treatment failure was reported. Conclusions. There is no one general-purpose surgical technique to treat corneal perforations. The complex nature of this pathology remains the individual, careful but also very distinct and multifactorial approach.

Partial lamellar keratoplasty for peripheral corneal disease using a graft from the glycerin-preserved corneoscleral rim.

To evaluate the feasibility of partial lamellar keratoplasty (LK) for treatment of peripheral corneal disease (PCD) using a graft from the corneoscleral rim preserved in glycerin. Patients who underwent LK for PCD at Shandong Eye Hospital from January 2006 to December 2012 were included. Corneoscleral rims of donor grafts, out of which the corneal buttons had been punched and used for penetrating keratoplasty, were preserved in glycerin and used for LK procedures. A trephine of 7.5-8.0mm was used to mark the central cornea. An excision was made according to the size of the lesions, after which a partial ring-shaped corneoscleral graft was transplanted to repair the peripheral cornea. Visual acuity, refractive astigmatism, and complications were monitored. There were 26 patients (28 eyes), including 15 patients with Terrien's marginal degeneration, eight with Mooren's ulcer, two with Wegener's granulomatosis, and one with peripheral corneal ulcer. The mean follow-up was 15months (range, 6-36months). Uncorrected visual acuity was improved by a mean of 3.17 Snellen chart lines (P = 0.010), and best spectacle-corrected visual acuity was improved by a mean of 0.85 Snellen chart lines (P = 0.045) at 6months after surgery. The refractive astigmatism decreased by 5.1 ± 8.6 diopters (P = 0.003). Two patients suffering graft ulcers (recurrence) were successfully treated by a second partial LK. No graft rejection occurred. Partial LK using a graft from the corneoscleral rim appears to be effective in the treatment of patients with PCD. This approach saves the donor graft, which is important in the countries or regions with scarcity of donor tissue.

Modified Surgical Epikeratoplasty for Keratoglobus: Anatomic and Visual Findings

Introduction: Keratoglobus is a controversial issue and still remains as one of the ambiguous corneal disorders; it can be managed by different surgical techniques successfully; yet the risk of globe rupture is high in these patients due to corneal weakness. In cases of progressive involvement, a large corneal graft is needed due to extreme thinness of the cornea. Recent adventures in surgical techniques have led to the introduction of new managements particularly in Keratoglobus treatment such as the "tuck procedure" in which a 12 mm corneo-scleral graft is miniaturized at its peripheral margin. A pocket is formed at the limbus of the recipient and the donor graft is "tucked" into it. We present a case of epikeratoplasty in Keratoglobus management. Case: A 45-year-old man with no history of a systemic disease underwent epikeratoplasty with the diagnosis of advanced bilateral keratoglobus since three years and six months before in the left and right eye, respectively. Pachymetry and best-corrected visual acuity (BCVA) were recorded before and six months after surgery. The highest recorded BCVA was 5/200 before the operation, whereas it was measured 6/10 (left eye) and 4/10 (right eye) at six-month follow-up examinations. Pachymetric findings improved from 244 to 773 and 212 to 744 (thinnest points) in the left and right eyes, respectively. Conclusion: Epikeratoplasty is a relatively safe, effective and reversible extraoccular procedure in the management of keratoglobus. It can also be performed to flatten the cornea and protect it against acute corneal hydrops and perforation.

A traumatic corneoscleral epithelial cyst

We describe a case of a patient with a corneoscleral epithelial cyst originating from a traumatic scleral rupture. Ultrasound biomicroscopy (UBM) and in vivo confocal microscopy (IVCM) were used to diagnose this rare condition. A lamellar corneoscleral graft was performed with histopathological examination of the excised cyst. The treatment of corneoscleral epithelial cysts is discussed.

Fuchs’ Superficial Marginal Keratitis Managed with Circumferential Marginal Corneoscleral Lamellar Patch Graft

To report a case of Fuchs' superficial marginal keratitis managed with circumferential marginal corneoscleral lamellar patch graft. Interventional case report. A 34-year-old man presented with several years' history of ill-defined symptoms of binocular ocular irritation associated with vision loss, mostly in the left eye. A superior marginal corneal thinning was found at biomicroscopy of the left eye, with 2 finely vascularized descemetoceles, and a gray epithelial demarcation line without lipid infiltrates. The right eye was clinically normal. Anterior segment optical coherence tomography demonstrated an important corneal thinning from the 7 o'clock to 3 o'clock positions, without scleral involvement. A circumferential marginal corneoscleral lamellar patch graft was done involving 3 mm of sclera and 3 mm of cornea. Fuchs' superficial marginal keratitis is a rare entity, mostly affecting young adults. It should be considered part of a spectrum of corneal thinning disorders, together with Terrien's marginal degeneration. Definitive treatment with a marginal corneoscleral lamellar patch graft with or without conjunctival autograft is suggested.