Large-diameter lamellar keratoplasty in severe ocular alkali burns - A technique of stem cell transplantation

Purpose: To evaluate the efficacy of large-diameter lamellar keratoplasty in cases of severe ocular alkali burns. Design: Prospective, noncomparative, interventional case series. Participants: Nine eyes of nine patients with severe ocular alkali burns (grade III/IV) exhibiting corneal vascularization, conjunctivalization, and chronic inflammation weve recruited from the Cornea Clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, a tertiary eye cave center. Intervention: Large-diameter lamellar keratoplasty was performed using McCarey-Kaufman media-preserved donor corneas. The patients were followed up for a minimum of 6 months. Main Outcome Measures: Symptomatic relief, time to epithelialization, best-corrected visual acuity, Schirmer I, tear film break-up time, and central corneal clarity were the parameters evaluated. Results: The mean duration between the injury and surgery was 29.5 +/- 19.4 months. No intraoperative complications were seen. Successful epithelialization of the ocular surface was achieved in all but one eye, and the mean time to epithelialization was 5.2 +/- 4.9 days. One eye had a persistent epithelial defect which was managed with a bandage soft contact lens. All patients achieved symptomatic relief. The preoperative best-corrected visual acuity was less than or equal to 1/60 in all the patients. There was a significant improvement in vision in six eyes postoperatively (P = 0.013). The corneal clarity was grade 2+ or better in five eyes and 1+ in four eyes. No recurrence of corneal vascularization or signs of rejection were seen in any eye during the mean follow-up of 7.4 +/- 3.2 months. Causes of no improvement of vision included the presence of subepithelial nebulomacular haze in one eye caused by persistent epithelial defect and residual stromal haze. Conclusions: Large-diameter lamellar keratoplasty is a useful therapeutic modality in cases of severe alkali burns. It is a single-stage procedure that provides a stable ocular surface because of stem cell supplementation and may visually rehabilitate the patient. Ophthalmology 2000;107:1765-1768 (C) 2000 by the American Academy of Ophthalmology.