yndrome.

The decision making for glaucoma management with the thinning present is complex. The absence of reliable sclera poses difficulties in suturing of a plate for a glaucoma drainage implant. An option could be posterior plate location and a pars plana location of the tube at the time of lensectomy and vitrectomy. Also, the use of fibrin glue to secure the plate to the sclera as a substitute for the sutures has been reported \[[@B21]--[@B23]\]. Another approach, if topical pharmacotherapy is not successful, is cyclophotocoagulation with adjusted energy parameters \[[@B24]\]. This could again be achieved transsclerally or with an endoscopic technique at the time of the lensectomy.

4. Conclusion {#sec4}
=============

Patients with Brittle Cornea Syndrome require close monitoring, use of protective polycarbonate lenses, and appropriate lifestyle modifications in order to prevent ocular rupture. High-risk patients may require prophylactic corneal cross-linking or corneoscleral grafts. Surgical management in these cases can provide unique challenges due to impaired wound healing. Early diagnosis and continuous care with a multidisciplinary approach, including glaucoma management, are essential in order to prevent vision loss.

Disclosure
==========

All authors attest that they meet the current ICMJE criteria for authorship.

Conflicts of Interest
=====================

The authors have no financial disclosures: (TE, MR, NP, AB, AG, and MA).

Supplementary Materials {#supplementary-material-1}
=======================

###### 

Supplementary video: showing the approach of transcorneal lensectomy with synechiolysis and core vitrectomy in the right eye of case 1. The trocars were placed 0.5 mm anterior to the graft-host junction due to severe host circumferential corneoscleral thinning.

###### 

Click here for additional data file.

![Slit-lamp photography showing bilateral blue sclera in the right (a) and left (b) eye. Corneal graft in the right eye (1a) is large and clear with intact sutures.](CRIOPM2020-438