Combined penetrating keratoplasty with keratolimbal allograft transplantation in the treatment of severe corneal burns

Abstract

To study the clinical results of combined penetrating keratoplasty with keratolimbal allograft transplantation in the treatment of severe corneal burns. The present study consisted of 35 eyes (34 patients) with full thickness corneal opacities and extensive corneal conjunctivalization after severe corneal burns. The duration between the injury and the time of presentation ranged from four months to 23 years. Group A: Combined penetrating keratoplasty (PK) with annular keratolimbal allograft transplantation (KLAT) was performed in 19 eyes (18 patients). Group B: Total PK with a scleral rim was performed in 16 eyes (16 patients). Post-operative visual acuity, intraocular pressure, graft rejection and complications were monitored. The average follow up time was 24 (range from 15 to 28) months. (1) Vision: The number of eyes that obtained best corrected visual acuity > 0.05 was 18 eyes (95%) in group A and 14 eyes (84%) in group B at 6 months postoperatively (P = 0.582); 16 eyes (88%) in group A and 6 eyes (38%) in group B at 12 months (P = 0.006); 12 eyes (63%) in group A and 3 (7%) in group B at 24 months (P = 0.016). (2) Graft rejection: Nine allografts (47%) in group A and 8 grafts (50%) in group B developed limbal stem cell rejection (P = 1.000); 6 allografts (32%) in group A and 11 allografts (69%) in group B developed endothelium rejection (P = 0.044). The difference of endothelium rejection rate between group A and B was not significant at different times postoperatively. (3)COMPLICATIONS: Corneal epithelium defect occurred in 2 eyes (11%) in group A and 7 (44%) eyes in group B (P = 0.049); hyphema occurred in 2 eyes (11%) in group A and 8 eyes (50%) in group B (P = 0.022); hypotony occurred in 1 eye (5%) in group A and 6 eyes (38%) in group B (P = 0.032). PK combined with KLAT is an effective treatment for severe corneal burns at a late stage irrespective of the etiology. This procedure can restore visual function in severely damaged eyes. Patients treated with PK combined with KLAT show less complication and better prognosis as compared with patients treated with total PK with a scleral rim.