Failed Corneal Graft Due to Severe Corneal Vascularization - A Novel Quadruple Strategy

Despite being a successful form of human organ transplantation, corneal grafts still carry the risk of primary and secondary graft failures.Factors such as ocular surface disease, immunological rejection, corneal vascularization, and late endothelial failure contribute to this risk.Each instance of graft failure necessitating a repeat graft increases the demand for corneal tissue and raises the likelihood of subsequent graft failures.Addressing issues, such as dry eyes and corneal vascularization during repeat corneal grafts, can enhance the chances of graft survival.In this context, we present the case of a 51-year-old female who was diagnosed with a failed therapeutic penetrating keratoplasty graft in the right eye due to grade 4 corneal vascularization, resulting in visual acuity limited to counting fingers close to the face.To address this, a novel quadruple approach involving optical penetrating keratoplasty, 360-degree peritomy, amniotic membrane graft with adjuvant selective fine needle diathermy, and lateral temporary tarsorrhaphy was performed on the right eye.At the tenth-week postoperative visit, her visual acuity improved to Snellen 6/24 with grade 4 graft clarity, showing no epithelial defects and vascularization.By incorporating cost-effective and simple adjuvant measures like peritomy, temporary tarsorrhaphy, and amniotic membrane grafting during repeat corneal grafts, there is a potential for increased graft survival and early rehabilitation.