title: Anterior segment transplantation with a novel biosynthetic graft.
abstract: OBJECTIVE
  Staphylectomy with sclerokeratoplasty has been performed in cases with large anterior staphyloma. This report describes a technique using a new biosynthetic graft to simulate the anterior segment in the eye of a 4-month-old child with diffuse anterior staphyloma and cataractous lens with compromised zonules.
  
  
  METHODS
  The graft had a biologic part (corneoscleral button) and a synthetic part (aniridia intraocular lens). Two partial thickness flaps and sclerotomies were made in the graft through which the lens haptics were externalized. After staphylectomy and lensectomy of the host, the graft was sutured. After intrascleral tuck of the lens haptics before fibrin glue-assisted flap closure was then done.
  
  
  RESULTS
  On the first postoperative day, the child was following light with the operated eye, and closure of the lids and cosmesis were markedly improved. Between the first and fourth month follow-up, and with the normal eye occluded, the child was following light and reaching out for objects. The cornea was clear with no evidence of rejection or failure. At 5 months, a persistent epithelial defect developed, leading by 6 months into a nebulomacular opacity partially obscuring the pupil. At 6 months, the results of the technique are anatomically and cosmetically satisfactory; however, a longer follow-up term will establish the visual benefits.
  
  
  CONCLUSIONS
  This technique may provide a suitable cosmetic and anatomic alternative to conventional procedures like staphylectomy with sclerokeratoplasty. It also retains the potential for more effective visual rehabilitation as an intraocular lens has been implanted.
authors.affiliation: Cornea Services, Dr Agarwal Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India.
authors.forename: Soosan
authors.initials: S
authors.lastname: Jacob
authors.forename: Gaurav
authors.initials: G
authors.lastname: Prakash
authors.forename: Dhivya
authors.initials: D
authors.lastname: Ashok Kumar
authors.forename: Vidya
authors.initials: V
authors.lastname: Nair
authors.forename: Athiya
authors.initials: A
authors.lastname: Agarwal
authors.forename: Amar
authors.initials: A
authors.lastname: Agarwal
mesh_terms: D000869:Anterior Eye Segment; D001705:Bioprosthesis; D002386:Cataract / Q000150:complications; D002387:Cataract Extraction; D003316:Corneal Diseases / Q000150:complications / Q000601:surgery*; D016039:Corneal Transplantation; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019654:Lens Implantation, Intraocular; D012590:Sclera / Q000637:transplantation; D016896:Treatment Outcome