Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage

Abstract

Purpose To evaluate the efficacy of autologous limbal transplantation (ALT) combined with deep lamellar keratoplasty (DLK) for ocular surface reconstruction and corneal clarity recovery in eyes with severe late-stage chemical or thermal burns. Design Retrospective, noncomparative, interventional case series. Participants Thirty-nine eyes of 39 patients with a history of severe chemical or thermal burns over 6 months (mean, 47 ± 28.7 months) exhibiting corneal vascularization, conjunctivalization, and heavy corneal scarring were treated at two university hospitals. Methods Surgical procedures included excising epibulbar fibrous tissue, clearing the fibrovascular membrane over the cornea, deep removal of corneal stroma 7.5 to 8.0 mm in diameter, exposing Descemet’s membrane in the pupillary area, grafting a corneal button, transplanting autologous limbal and conjunctival epithelial grafts, and making a temporary tarsorrhaphy. Main outcome measures Integrity of ocular surface recovery, postoperative corneal epithelial stability, optical corneal clarity, and best-corrected visual acuity were the outcome measurements. Results Thirty-four of 39 eyes that received ALT combined with DLK met the criteria of the study. Of 34 operated eyes, full corneal epithelialization was achieved in 19 eyes (55.9%) within 5 days and in 32 eyes (94.1%) within 7 days after surgery. Delayed epithelial healing occurred in two eyes (5.9%). The reconstructed corneal surface remained stable, and the renewed epithelium was characterized cytologically by nonkeratinized squamous cells without goblet cells. After surgery in 11 of 34 eyes, fluid was identified between Descemet’s membrane and the donor corneal graft, resulting in a pseudochamber that completely resolved in 10 eyes within 30 days. In one patient, a persistent pseudochamber was present for 28 months. After surgery, transparent cornea especially in the pupillary area was accomplished in 29 eyes, whereas mild cornea clouding, nebulomacular corneal opacity, and heavy corneal scarring were observed, respectively, in three eyes. In addition, corneal endothelial decompensation was identified in two eyes and demonstrated persistent corneal epithelial and stromal edema. Remarkable improvement of postoperative vision was achieved in 30 eyes. Four eyes without postoperative improvement in vision were regrafted by penetrating keratoplasty at least 6 months after the original ALT and DLK surgery. Conclusions Autologous limbal grafting combined with DLK simultaneously can restore a normal and stable ocular surface, create clear central cornea, and remarkably enhance visual acuity after severe chemical or thermal burns.