To present the benefit of preserved sclera for immediately repairing perforated corneal ulcer and report the clinical outcome of patients undergoing penetrating keratoplasty after scleral patch graft.The results of perforated corneal ulcer patients, who underwent penetrating keratoplasty after scleral patch graft between January 1996 and December 2002, were reviewed retrospectively. The causes of the corneal ulcer were also included.Penetrating keratoplasty was performed after scleral patch graft for perforated corneal ulcer on four patients, three males and one female. The culture results from corneal scraping showed Fusarium spp in two cases and Streptococus pneumoniae in one. One patient had a presumed bacterial corneal ulcer. The post-penetrating keratoplasty visual acuity ranged from hand motions to 20/40.The scleral patch graft procedure for perforated corneal ulcer may benefit in circumstances of unavailable corneal donors. The results of penetrating keratoplasty after scleral patch graft were favorable.