Extensive Necrotizing Scleromalacia Following Glaucoma Surgery Repaired By A Large Corneoscleral Graft

Extensive necrotizing scleromalacia following glaucoma surgery repaired by a large corneoscleral graft

Kaplan Medical Center, Rehovot  and Meir Medical Center, Kfar Saba, Israel.

A 74 year-old female with progressive glaucoma in her right eye underwent PreserFlo® MicroShunt (PM) implantation with mitomycin C application. Two months postoperatively she developed blebitis and endophthalmitis. She underwent removal of the PM, pars plana vitrectomy with intravitreal vancomycin and ceftazidim injection and topical instillation. Culture was positive for pseudomonas. Extensive superior and nasal scleral necrosis was observed with nasal scleral perforation that was glued with Tutoplast®  pericardium patch graft and conjunctival flap. The eye became hypotonous with wide-spread superior and nasal scleral thinning and intractable pain. After 4 months the patient underwent a large corneoscleral covering graft surgery. A donor corneoscleral graft of 15 x 25 mm was excised to match the area of scleromalacia. Conjunctival peritomy and Tutoplast removal were performed. The graft was sutured to the limbal cornea and scleral healthy edges at 11 and 4 hours and glued with fibrin glue to the necrosed sclera beyond the equator. Four rotational large conjunctival flaps were glued and sutured to cover the scleral graft and temporary tarsorrhaphy was performed.

The hypotony and pain improved immediately. The corneoscleral graft covered the whole area of scleromalacia and became conjunctivalized. Six months postoperatively the eye is normotensive and painless. Visual acuity is counting fingers due to corneal distortion by the large limbal graft that is gradually improving.

A large donor corneoscleral graft with conjunctival flaps can be utilized to repair an extensive scleromalacia following necrotizing surgically induced scleritis.