Modified surgical epikeratoplasty for keratoglobus: anatomic and visual findings

Keratoglobus is a controversial issue and still remains as one of the ambiguous corneal disorders; it can be managed by different surgical techniques successfully; yet the risk of globe rupture is high in these patients due to corneal weakness. In cases of progressive involvement, a large corneal graft is needed due to extreme thinness of the cornea. Recent adventures in surgical techniques have led to the introduction of new managements particularly in Keratoglobus treatment such as the "tuck procedure" in which a 12 mm corneo-scleral graft is miniaturized at its peripheral margin. A pocket is formed at the limbus of the recipient and the donor graft is "tucked" into it. We present a case of epikeratoplasty in Keratoglobus management. A 45-year-old man with no history of a systemic disease underwent epikeratoplasty with the diagnosis of advanced bilateral keratoglobus since three years and six months before in the left and right eye, respectively. Pachymetry and best-corrected visual acuity [BCVA] were recorded before and six months after surgery. The highest recorded BCVA was 5/200 before the operation, whereas it was measured 6/10 [left eye] and 4/10 [right eye] at six-month follow-up examinations. Pachymetric findings improved from 244 to 773 and 212 to 744 [thinnest points] in the left and right eyes, respectively. Epikeratoplasty is a relatively safe, effective and reversible extraoccular procedure in the management of keratoglobus. It can also be performed to flatten the cornea and protect it against acute corneal hydrops and perforation.