Large-diameter lamellar keratoplasty in severe ocular alkali burns: A technique of stem cell transplantation

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Purpose To evaluate the efficacy of large-diameter lamellar keratoplasty in cases of severe ocular alkali burns. Design Prospective, noncomparative, interventional case series. Participants 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. Intervention Large-diameter lamellar keratoplasty was performed using McCarey-Kaufman media–preserved donor corneas. The patients were followed up for a minimum of 6 months. Main outcome measures 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.