Sclerokeratoplasty Versus Penetrating Keratoplasty in Anterior Staphyloma

Abstract

* BACKGROUND AND OBJECTIVE: To assess the efficacy of the newer surgical technique of sclerokeratoplasty in spherical anterior staphyloma of the cornea and to compare it with total penetrating keratoplasty. * PATIENTS AND METHODS: A randomized, prospective clinical trial in 20 eyes with acquired spherical anterior staphylomas was undertaken. Ten eyes each underwent sclerokeratoplasty (group 1) or total penetrating keratoplasty (group 2). The parameters evaluated were visual acuity, keratometry, graft status, and complications. Patients were observed for a minimum of 1 year. * RESULTS: Best spectacle-corrected visual acuity of 6/60 or better with astigmatism of less than 3 D was achieved in all but one patient in group 1 in contrast to 5 cases in group 2. Postoperative complications included epithelial defects, shallow anterior chamber, hyphema, and uveitis, which did not significantly vary between the 2 procedures. Secondary glaucoma was significant associated with group 2 as compared with group 1. At the end of 1 year, no significant difference in the graft clarity was present. Grafts were clear 3+ or more in 8 eyes in group 1 and in 5 eyes in group 2. Good cosmetic results were achieved in cases of sclerokeratoplasty due to the absence of corneal opacification and suture marks. * CONCLUSION: Sclerokeratoplasty is a useful alternative to total penetrating keratoplasty in cases of acquired spherical anterior staphylomas of the cornea with good anatomic and useful visual outcome. [Ophthalmic Surg Lasers 1999; 30: 31-36.]

Total Anterior Staphyloma Secondary to Acanthamoeba Keratitis

“…Acquired anterior staphylomas usually occur in developing nations and are often secondary to fungal microbial keratitis and trauma. 1,3 Indeed, in some studies from the developing world, anterior staphyloma has a high enough prevalence to be a major indication for evisceration with suggestions that the relatively high prevalence may be related to socioeconomic deprivation and trauma. 4 Anterior staphylomas are a rare occurrence in the developed world and are usually secondary to chronic inflammatory disorders such as rheumatoid scleritis.…”

Sclerokeratoplasty for the early management of acquired anterior staphyloma

“…The treatment of anterior staphyloma usually involves evisceration of the affected eye, and sclerokeratoplasty is a therapeutic alternative in order to restore the eyeball and prepare for a second intervention [5,6,8].…”

“…Many cases culminate with evisceration. Therefore, emergency measures must be taken to avoid the spread of microorganisms, leading to endophthalmitis and compromise the internal structures of the eyeball [4,5].…”

“…The few treatment options, alternatives to mutilation, include penetrating keratoplasty, sclerokeratoplasty, mushroom graft and dural patch [3,[5][6][7]. Due to the technical difficulty of treatment, the therapeutic options should be evaluated in a systematic and criterious way, in order to reduce intra and postoperative complications.…”

Management Challenge: A Case of Aniridia and Aphakia with Secondary Glaucoma in Sclerokeratoplasty

“…In addition, the chances of IOP rise after penetrating keratoplasty (PK) are higher in the aphakics. [5] The chances of graft' failure are at spike if immediate and efficient interventions for IOP control post keratoplasty are not performed. Moreover, these interventions (whether medical or surgical) may interfere with the graft's viability and survival in a negative manner [6].…”