Eine tektonische exzentrische Sklerokeratoplastik à chaud gefolgt von einer partiellen Bindehautdeckung zur Behandlung eines perforierten Hornhautulkus bei Morbus Wegener

Purpose: This case report describes the surgical treatment of a 70-year-old female patient with a massively reduced general condition, painless redness associated with a foreign body sensation, sensitivity to glare and increasing visual impairment of the right eye. Material and Methods: The clinical findings of the morphological anterior segment showed a most likely sterile infection with a limbus-parallel corneal stromal melting larger than 6 mm. The suspected granulomatosis with polyangiitis (Wegener’s disease) was confirmed in the extended autoimmune serology. The patient initially underwent a perforating tectonic eccentric sclerokeratoplasty à chaud. The aim was to preserve the eye. Eighth months after the eccentric perforating sclerokeratoplasty, a new perforation developed, so a partial conjunctival flap was then added. Results: The eye could be preserved because of the perforating tectonic eccentric sclerokeratoplasty à chaud and the additional partial conjunctival flap. As expected, the surgery did not improve vision but stabilised the eyeball. Conclusion: Patients with Wegener’s disease involving the eye have the worst ocular prognosis, as they more frequently develop necrotising anterior scleritis as well as a loss of visual acuity and peripheral ulcerative keratitis. The current therapeutic approach initially involves surgical treatment of the corneal melting and, of course, stabilisation of the eyeball in the case of perforation. Partial or complete conjunctival flaps are used for severe, chronic and painful corneal surface problems when all other treatment options have failed