The Castroviejo square graft: a retrospective study

We examined 19 eyes of 12 patients who had undergone penetrating keratoplasty utilizing the Castroviejo square graft technique. The visual acuities at the time of examination for inclusion in the study ranged from 20/30 to counting fingers. Of the 19 original square grafts, eight were judged clear centrally with varying degrees of peripheral stromal haze, and one was hazy. The remaining eight failed with varying degrees of irreversible corneal edema. The eight corneas obtained following repeat penetrating keratoplasty were studied with light and electron microscopy. The donor/recipient corneal stromal lamellae were continuous at the graft-host junction, particularly in the mid-stromal area. Disruptions in Descemet's membrane were present at the wound; transmission electron microscopy revealed differences in the composition of Descemet's membrane between the graft and the host. Two additional square grafts had failed, and the patients were awaiting keratoplasty. Nine of the 19 grafts were judged functionally clear, with six of the nine requiring contact lens correction.