Corneal-scleral thinning and perforation can result from a number of conditions, ranging from the corneal destruction sometimes seen in chronic diseases such as rheumatoid arthritis, to more acute conditions such as acute inflammation associated with herpes simplex or other microbial infections. In many of these conditions, it may neither be possible or prudent to close the wound edges primarily nor to perform a traditional penetrating keratoplasty (PKP). In order to prevent an impending perforation or to provide tectonic support for an actual perforation, a patch graft with a variety of different donor materials may be considered. Use of both scleral tissue and pericardium has been described to reinforce corneal-scleral defects caused by disease as well as surgical complication. Each material has its own advantages and disadvantages. Processed pericardium offers the advantages of ready availability, long shelf-life and easy storage, sterilization and immunologic inactivation, as well as uniform thickness and ease of use. It also acts as an effective scaffold for regenerating epithelium. Although it has far more tensile strength than amniotic membrane, it is too porous and insufficiently rigid to be used alone in the repair of a significant perforation. On the other hand, it can easily be fashioned for placement onto a descemetocele with the strategy of preventing further corneal dissolution through its ability to encourage resurfacing. Alternatively, in the setting of a corneal-scleral fistula, it can be used to bridge the wound, and a covering conjunctival graft then placed over it to maintain adequate integrity. Sclera is much less pliable than is pericardium and can be difficult to shape with scissors. Although partial-thickness scleral grafts can be prepared, this is technically challenging. In a large, full-thickness repair of a corneal-scleral defect, banked or preserved sclera provides a tectonic strength that cannot be achieved with pericardial tissue.