Tectonic Keratoplasty to Restore the Bulbar Wall after Block Excision of Benign and Malignant Intraocular Tumors

Figure 1

Patient 1 UBM before surgery and after uveo-scleral excision en bloc. (a) Left: longitudinal scan at the 6 o’clock position (L6) shows a solid thickening of the ciliary body and the anterior choroid; the corresponding anterior chamber angle is infiltrated, the acoustic structure is heterogeneous, and the internal reflectivity is medium. Right: transversal scan at the 5:30 o’clock position (T5:30) shows the double dome-shaped morphology of the lesion at the level of the anterior choroid and the circumscribed growth into the overlying sclera, which appears hypoechoic (white arrow). (b) Patient 1: slit lamp examination presurgery. Image shows a confined pigmented nodular growth of uveal melanoma through the sclera, at about 6 mm from the limbus, under the conjunctival layer. (c) After Hanna trephination, block excision is completed with scissors until removing the entire lesion and the overlying infiltrated sclera. (d) Tectonic corneal graft covers the scleral defect and is sutured with 16 interrupted Nylon 10.0 sutures. (e) Corneal graft is well integrated into the sclera, under the conjunctiva, about 4 years after surgery.