Anterior segment transplantation with a novel biosynthetic graft

Staphylectomy with sclerokeratoplasty has been performed in cases with large anterior staphyloma. This report describes a technique using a new biosynthetic graft to simulate the anterior segment in the eye of a 4-month-old child with diffuse anterior staphyloma and cataractous lens with compromised zonules.

The graft had a biologic part (corneoscleral button) and a synthetic part (aniridia intraocular lens). Two partial thickness flaps and sclerotomies were made in the graft through which the lens haptics were externalized. After staphylectomy and lensectomy of the host, the graft was sutured. After intrascleral tuck of the lens haptics before fibrin glue-assisted flap closure was then done.

On the first postoperative day, the child was following light with the operated eye, and closure of the lids and cosmesis were markedly improved. Between the first and fourth month follow-up, and with the normal eye occluded, the child was following light and reaching out for objects. The cornea was clear with no evidence of rejection or failure. At 5 months, a persistent epithelial defect developed, leading by 6 months into a nebulomacular opacity partially obscuring the pupil. At 6 months, the results of the technique are anatomically and cosmetically satisfactory; however, a longer follow-up term will establish the visual benefits.

This technique may provide a suitable cosmetic and anatomic alternative to conventional procedures like staphylectomy with sclerokeratoplasty. It also retains the potential for more effective visual rehabilitation as an intraocular lens has been implanted.