Cross-Linking as an Adjuvant Treatment for Tectonic Corneal Lamellar Graft Preparation

George D. Kymionis*, 1, Argyro D. Plaka1, Vasilios F. Diakonis1, Michael A. Grentzelos1, Georgios A. Kontadakis1, Andreana C. Mersinoglou2, Efstathios T. Detorakis1, Fotis Topouzis2
1 Vardinoyiannion Eye Institute of Crete (VEIC), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
2 Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

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© Kymionis et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the University of Crete, Faculty of Medicine, Vardinoyiannion Eye Institute of Crete (VEIC), 71003 Heraklion, Crete, Greece, Tel: +302810371800, Fax: +302810394653, E-mail:



To describe a new surgical approach for the tectonic reconstruction of the anterior ocular segment and the management of scleral and conjuctival melting.


Case series of patients demonstrating anterior segment anomalies, such as scleral and conjunctival melting. The anterior stromal part of a pre-cut corneal graft for Descemet’s stripping automated endothelial keratoplasty (DSAEK) was cross-linked with riboflavin and ultraviolet A irradiation and was used to cover scleral (scleral melting in a patient with necrotizing scleritis, one case) and conjuctival (dehiscence of the conjunctiva in patients with anti-glaucomatous valve exposure, two cases) areas. The endothelial part of all corneal grafts was used for DSAEK in patients with need of corneal endothelial transplantation.


Repair of scleral and conjuctival melting was successful in all cases. No intra- or post- operative complications occured. Visual acuity of all patients remained stable during the follow up period. One year postoperatively the corneal graft remained in place and no signs of inflammation were evident, while all grafts were epithelialized.


The use of cross-linked corneal graft for the tectonic reconstruction of the anterior ocular segment represents an adequate surgical approach for the management of scleral and conjuctival melting; while, at the same time it offers the advantage of using one corneal graft for two recipients.

Keywords: : Corneal collagen cross-linking, scleral melting, conjuctival melting, corneal transplantation.