[Cause and repair of a corneoscleral fistula in two patients].

BACKGROUND

A slowly progressing bulbar hypotension with maculopathy in a male patient as well as an endophthalmitis in a female patient both required surgical repair of posttraumatic leaks.

PATIENTS AND METHODS

In a 32-year-old male patient, a filtration bleb leak occurred 4 months after a penetrating stab wound in the corneoscleral region. Persistent bulbar hypotension demanded microsurgical revision, revealing a 1 x 1 mm scleral defect. The leakage area was close to the limbus. In a 75-year-old female patient, signs of endophthalmitis occurred 4 years after extracapsular cataract extraction with posterior intraocular lens implantation. The place of entry of the inflammation was a 1 x 3 mm subconjunctival fistula in the corneoscleral scar. In both cases the leakage areas were repaired by an autologous 4 x 4 mm scleral graft obtained from the pars plana region in the same eye.

RESULTS

The postoperative course was without complications, the intraocular pressure was back to normal within a few days in both cases. Two weeks after surgical repair in the first patient, normal ocular fundus and normal visual acuity were observed. In both cases complete and permanent leakage closure was achieved.

CONCLUSIONS

There are various surgical possibilities for the repair of scleral defects. Patching the defects with autologous scleral grafts has several advantages. Dissection of the graft in the pars plana region is relatively simple. The graft comprising 30% of the scleral thickness is sufficiently firm and supple and there is no danger of infection transmission or of rejection.