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The management of severe sclerokeratitis following corneal transplantation surgery
  1. R Maini,
  2. J K G Dart
  1. Moorfields Eye Hospital, London, UK
  1. Correspondence to: Mr R Maini FRCOphth, Department of Ophthalmology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; rmaini{at}doctors.org.uk

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There is a paucity of information in the scientific literature regarding post keratoplasty inflammation and the management of this rare but serious problem. Although corneal graft survival is known to be reduced when keratoplasty is undertaken in inflamed eyes,1 and published data are available for patients with known risk factors of atopy2 and acanthamoeba keratitis,3 little is known in this regard for grafted eyes in individuals without discernable risk factors who develop severe (non-rejection) inflammation following surgery.

We describe a series of six disparate patients who developed severe scleral inflammation in the postoperative period and outline our management strategy in each case. Scleritis was diagnosed using the following criteria: severe diffuse scleral inflammation associated with pain and photosensitivity. All the cases manifested diffuse rather than nodular scleral involvement without involvement of the residual host cornea. The corneal grafts were secured using 10/0 nylon monofilament suture mounted on a 3/8 circle side-cutting stainless steel needle (Catalogue No 8065-208001 Alcon Laboratories, Hemel Hempstead, UK). Two cases are described in detail and a comparison in all the cases of the salient features is made in a summary table 1.

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Table 1

 Summary of each patient and their clinical course (including ocular history) before and after developing postoperative scleral inflammation

Case reports

A 40 year old man presented with a left central corneal abscess. He had been treated for a presumed episode of herpetic epithelial keratitis and conjunctivitis several years before this but had had documented recurrent corneal erosion syndrome and blepharitis for the previous 2 years. On examination his left visual acuity was hand motions. He was found to have a central left corneal abscess 2.3 mm in width and 2.6 mm in height; this was covered by a mucous …

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