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Cornea. 2009 Jan;28(1):51-7. doi: 10.1097/ICO.0b013e3181852673.

Living-related conjunctival-limbal allograft for chronic or delayed-onset mustard gas keratopathy.

Author information

1
Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran. ma_javadi@yahoo.com

Abstract

PURPOSE:

To determine the long-term outcomes of living-related stem cell transplantation in patients with delayed or chronic mustard gas keratopathy (MGK).

MATERIALS AND METHODS:

In this noncomparative interventional case series, 21 consecutive patients with advanced delayed or chronic MGK received living-related conjunctival-limbal allograft and were followed up for at least 1 year. All subjects received immunosuppression with systemic cyclosporine. Main outcome measures were reduction of subjective complaints, corneal epithelial healing, and regression of corneal neovascularization adjacent to the transplant area.

RESULTS:

Twenty-five eyes of 21 patients (all male), including 4 patients who received bilateral grafts, were operated. Mean age at the time of surgery was 35.8 +/- 3.8 years, mean interval between mustard gas exposure and surgery was 12.2 +/- 3.5 years, and mean follow-up was 37.2 +/- 18.5 months. Average size of the donor lenticule was 71.16 +/- 17.34 degrees. Simultaneous penetrating and lamellar keratoplasty were performed in 5 and 2 eyes, respectively. All patients consistently reported marked subjective improvement. Mean time for epithelial healing was 7.76 +/- 3.2 days. Visual acuity was 1.35 +/- 0.81 LogMAR before surgery, which improved to 0.59 +/- 0.34 LogMAR 3 months after the procedure (P < 0.001). Mean visual acuity at final examination was 0.82 +/- 0.49 LogMAR (P = 0.001). Acute stem cell rejection was observed in 10 (40%) eyes, which improved by increasing the dose of topical and systemic steroids. Chronic stem cell rejection was diagnosed in 8 (32%) eyes, which led to failure in 5 (20%) eyes.

CONCLUSIONS:

Living-related conjunctival-limbal allograft is effective in stabilizing the ocular surface in patients with delayed or chronic MGK.

PMID:
19092406
DOI:
10.1097/ICO.0b013e3181852673
[Indexed for MEDLINE]
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