Corneoscleral block excision grafts: indications, techniques, and outcomes

The purpose of this article is to discuss the indications, techniques, and outcomes for corneoscleral grafts in sight-threatening ocular disease.

We conducted a single-center review of 12 medical records of patients who underwent corneoscleral grafts by a single surgeon (R.K.F.) from 1983 through 2004.

The 4 primary indications for undergoing a corneoscleral graft included infection, anterior chamber cyst, epithelial downgrowth, and invasive squamous cell carcinoma. The surgical technique involved en bloc excision of the lesion followed by placement of cadaveric corneoscleral tissue to reapproximate the original structures in the region. The surgical technique was modified to suit the individual indication and degree of involvement. Visual acuity, recurrence, complications, and time to rehabilitation are discussed. Histopathologic evaluation for each case was performed. Best-corrected visual acuity improved in 3 of 12 eyes. Vision of 20/50 or better was maintained in 5 of 12 eyes, and a visual acuity between 20/60 and 20/300 was achieved in 5 of 12 eyes. One patient with epithelial downgrowth had progression to phthisis bulbi, and 1 patient with squamous cell carcinoma experienced recurrence of the primary disease process resulting in enucleation.

Patients undergoing placement of large corneoscleral grafts have a guarded prognosis; however, this extensive, technically difficult, surgical intervention may allow patients to preserve and/or improve their visual function.