Large-diameter lamellar keratoplasty in severe ocular alkali burns: A technique of stem cell transplantation.
OBJECTIVE
To evaluate the efficacy of large-diameter lamellar keratoplasty in cases of severe ocular alkali burns.


METHODS
Prospective, noncomparative, interventional case series.


METHODS
Nine eyes of nine patients with severe ocular alkali burns (grade III/IV) exhibiting corneal vascularization, conjunctivalization, and chronic inflammation were recruited from the Cornea Clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, a tertiary eye care center.


METHODS
Large-diameter lamellar keratoplasty was performed using McCarey-Kaufman media-preserved donor corneas. The patients were followed up for a minimum of 6 months.


METHODS
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 </=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.
Vajpayee
R B
RB
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Thomas
S
S
Sharma
N
N
Dada
T
T
Tabin
G C
GC
D000293:Adolescent; D000328:Adult; D000468:Alkalies / Q000009:adverse effects*; D002057:Burns, Chemical / Q000601:surgery*; D002648:Child; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation; D019573:Epithelium, Corneal / Q000637:transplantation*; D005126:Eye Burns / Q000139:chemically induced* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D033581:Stem Cell Transplantation; D016896:Treatment Outcome; D014792:Visual Acuity
D000468:Alkalies