title: Lamellar keratoplasty and keratolimbal allograft for mustard gas keratitis.
abstract: OBJECTIVE
  To report the clinical outcomes of lamellar keratoplasty (LKP) in patients with delayed-onset mustard gas keratitis and to compare visual acuity and graft survival rates between subgroups with simultaneous or sequential keratolimbal allograft and LKP.
  
  
  METHODS
  Retrospective, comparative, interventional case series.
  
  
  METHODS
  Fifty-two eyes of 37 male survivors of chemical warfare with mustard gas keratitis who underwent LKP were included. The results were evaluated with respect to best spectacle-corrected visual acuity (BSCVA), refractive error and keratometry readings, and graft clarity. Thirty-two eyes required stem cell transplantation (keratolimbal allograft), which was performed before or concomitant with LKP. The groups with sequential and concomitant intervention were compared regarding BSCVA, refraction, corneal graft surface stability, and stem cell and corneal graft survival rates.
  
  
  RESULTS
  The mean patient age at the time of surgery was 43.4 ± 8.2 years, and the mean follow-up period was 41.4 ± 19.6 months. The mean preoperative BSCVA was 0.51 ± 0.48 logarithm of the minimal angle of resolution units, which increased to 0.33 ± 0.18 logarithm of the minimal angle of resolution units (P = .03). The mean preoperative spherical equivalent refractive error was -2.40 ± 1.5 diopters, which remained unchanged after surgery (-1.52 ± 3.7 diopters; P = .77). No significant difference between the sequential and simultaneous subgroups was found with regard to postoperative BSCVA, refraction, keratometry readings, or corneal graft survival (90.3% and 89.9%, respectively; P = .68). However, the latter group had statistically better stem cell graft survival (40.0% vs 100% at month 41, respectively; P = .02).
  
  
  CONCLUSIONS
  LKP is an effective method of corneal transplantation in mustard gas victims. When stem cell and corneal transplantation are indicated, the simultaneous approach can yield better results than staged intervention.
authors.affiliation: Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Jafarinasab
authors.forename: Sepehr
authors.initials: S
authors.lastname: Feizi
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Javadi
authors.forename: Farid
authors.initials: F
authors.lastname: Karimian
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Soroush
mesh_terms: D000328:Adult; D000368:Aged; D002057:Burns, Chemical / Q000503:physiopathology / Q000601:surgery*; D002619:Chemical Warfare Agents / Q000009:adverse effects; D016039:Corneal Transplantation; D004847:Epithelial Cells / Q000637:transplantation; D019573:Epithelium, Corneal / Q000637:transplantation; D005126:Eye Burns / Q000139:chemically induced* / Q000503:physiopathology; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007492:Iran; D007634:Keratitis / Q000139:chemically induced / Q000503:physiopathology / Q000601:surgery*; D016850:Limbus Corneae / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009151:Mustard Gas / Q000009:adverse effects*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D014792:Visual Acuity / Q000502:physiology
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas