BACKGROUND Corneo-scleral ulcerations and perforations are severe complications after most severe eye burns. One possibility to handle this situation is a keratoplasty with a scleral rim. This retrospective study was carried out to show the outcome after total replacement of the cornea after most severe eye burns. METHODS Between 1986 and 1991 we carried out 12 keratoplasties with a scleral rim in 9 most severely burnt eyes of 7 patients. In 9 cases this intervention was the first transplantation. In 3 eyes a re-keratoplasty had to be carried out. RESULTS All eyes could be saved after this surgical intervention, although all but two transplants failed. In eight cases the transplant decompensated and/or was replaced by scar tissue. Two transplants remained clear. Visual acuity was light perception in five cases, intact light projection in two cases, 1/35 in one case because of cataract formation and 0.8 in another case at the end of the observation period. The reasons for graft failure were multifactorial. Epithelial problems were the reason for graft failure in eight cases. Two of these also showed shrinkage of the eye lids with incomplete lid closure. In six cases severe vascularisation with scar formation was observed. It is remarkable that immunoreactions occurred only in four cases. This may be due to the fact that all patients were treated systemically with cyclosporin A. In one case the transplant failed after extensive surgery of the anterior segment. CONCLUSIONS Our results show that the keratoplasty with a scleral rim can save the eye in the difficult situation of corneo-scleral ulceration or perforation. Nevertheless a visual rehabilitation could not be achieved in seven of nine cases. But all eyes were in a satisfying condition for further smaller transplants to achieve better visual acuity.