[Eccentric tectonic mini-keratoplasty in corneal, corneoscleral and scleral processes]

Between 1975 and May 1983 so-called tectonic "mini"-keratoplasties (i.e. grafts of 2 to 6 mm in diameter) were carried out on 30 patients because of perforating corneal lesions (12 patients), corneo-scleral fistulae (17 patients), and scleral fistulae (1 patient). Two different surgical procedures are distinguished in closing the corneo-scleral and the sclera fistula, namely the tectonic transplantation of a cornea of full thickness into a lamellar layer and the closure of a perforating defect or of a block excision. In two cases the perforating tectonic keratoplasty was combined with an i.c. cataract extraction, in three other patients it was combined with an iridoplasty, a direct cyclopexia after cyclodialysis, or with an anti-glaucomatous direct pars plicata excision. In two cases the eccentric tectonic mini-keratoplasty was followed by an autologous rotational keratoplasty carried out for optical reasons. In all patients the defect in the wall of the globe could be closed reliably and a normalization of the intra-ocular pressure was achieved. In two cases an early epithelial invasion occurred. The visual acuity improved in 19 patients. We recommend the eccentric tectonic mini-keratoplasty as the method of choice for closing corneal, corneo-scleral, and scleral fistulae.