Lamellar Keratoplasty and Keratolimbal Allograft for Mustard Gas Keratitis

Abstract

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. Retrospective, comparative, interventional case series. 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. 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). 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.