Sclerokeratoplasty with Maintenance of the Angle

Using sclerocorneal dissection and angle-support sutures to maintain the angle and its function, we performed 14-mm sclerokeratoplasty with placement of allograft tissue in five eyes of 15 patients. One previously operated-on eye required a second sclerokeratoplasty and three eyes required secondary optical keratoplasty after opacification of the original large graft. Patients were monitored from 11 to 90 months postoperatively. At the last examination, all patients had clear grafts and visual acuity had improved since the preoperative examination. All patients had intraocular pressure maintained within normal range (less than 22 mm Hg, as measured by pneumotonometry) except for two patients in whom transient increases were resolved by tapering of corticosteroid treatment. Our results suggested that sclerokeratoplasty, using angle-support sutures, is an effective treatment for diffuse destructive corneoscleral disease that cannot be managed with a smaller graft.