Scleral patch grafting for scleral wound thinning after pars plana phacoemulsification and aspiration: A case report

Trypan Blue and Endoillumination-Assisted Phacoemulsification in a Patient With Advanced Keratoglobus

Keratoglobus is a rare subset of noninflammatory corneal ectasia, which is a group of disorders characterized by corneal thinning, projection, and scarring. Patients with keratoglobus commonly present with poor vision. A case of advanced keratoglobus was managed by a modified phacoemulsification surgical technique using endoillumination and capsular staining with trypan blue. In this case, we present a 54-year-old man with keratoglobus. In January 2023, a modified phacoemulsification surgical technique using endoillumination was described with a video in a patient with bilateral corneal opacification, neovascularization, significant peripheral thinning, and moderate to severe corneal opacity in which cataract surgery had to be performed alone without considering penetrating keratoplasty. Postoperatively, the patient was doing well with no leaks. We may conclude that this method allows for better visualization during surgery and decreases the risk of intraoperative complications due to poor visualization in patients with severe corneal opacity.

The usability of lamellar scleral autograft in ocular perforation treatment

IMPORTANCE

Open globe injury is a frequent and preventable healthcare problem with an annual incidence of 3.5/100,000 worldwide. Management and treatment methods aim to ensure globe integrity. Unfortunately, it is not possible to achieve globe integrity in some of the cases, and these can result in poor visual outcomes.

PURPOSE

To evaluate the usability of lamellar scleral graft in the repair of ocular perforations.

METHODS

This was a retrospective review of 11 patients who underwent lamellar scleral graft surgery for ocular perforation between June 2015 and June 2020. Due to the failure of the repairs when other techniques were used, the perforation zones were sealed with lamellar scleral autografts. The primary measures of the outcomes were globe integrity, postoperative best corrected visual acuity, and intraocular pressure (IOP). Visual acuity was determined using the Snellen eye chart, and IOP was measured using the automated pneumatic tonometry during standard examination.

RESULTS

The participants enrolled in this study included 11 patients who underwent lamellar scleral patch graft between 2015 and 2020. The mean age of the patients was 58.81 ± 16.6 years (range, 16-77), and the mean follow-up period was 12.5 ± 3.8 months (range, 8-20). During the surgery, the perforation zone was treated and no leakage was observed. IOP significantly increased, and visual acuity improved in almost all eyes. The factors that made it necessary to use scleral grafts in patients were star-shaped wounds, delayed presentation, lost corneal / scleral tissue.

CONCLUSION

Lamellar scleral graft is a method that can be used in the treatment of defective ocular perforation with acceptable complications and provides adequate functional and structural stability. Scleral patch grafting can be considered as an alternative option for surgeons treating a variety of ocular conditions that cause tectonic imbalance or poor cosmesis.