[Reconstructive surgery of extremely severe chemical eye burn with perforation]

A 23-year-old female received a very severe burn in the anterior eye segment of both eyes from hydrochloric acid. During medical treatment over a period of 4 weeks in an outpatient clinic, the left eye perforated because of corneal and scleral ulceration. In the first emergency operation the necrotic tissue was excised in both eyes. Scleral ulceration in the right eye was treated by a tenonplasty. In the left eye a tenonplasty was carried out in all quadrants. Because of the large amount of ulceration in the cornea, a keratoplasty with a scleral rim was performed. On this occasion a fibrinous membrane was pulled off the iris. The cataractous lens released spontaneously. Finally an anterior vitrectomy was carried out. Two weeks later endophthalmitis occurred. Therefore, a vitrectomy was performed. Microbiological examination yielded mold fungus. Seven days after this operation another infiltration of the vitreous could be detected sonographically. During the third operation 10 mm of the first 16-mm transplant was trephined for another keratoplasty. An open-air vitrectomy was carried out as well. Nevertheless, the bulbus became phthisic afterwards. Amazingly the tenonplasty led to complete regeneration of the conjunctiva and healing of the scleral ulceration. It was possible to take an autologous transplant of the conjunctiva from the eye and graft it on the right eye to relieve a nasal superior symblepharon. After successful keratoplasty visual acuity of the right eye is 0.5.