Cornea Cases

Title:

Superficial anterior lamellar keratoplasty for residual corneal scarring after limbal stem cell transplantation

Case Report Details

First Author: R.Dondi ITALY

Co Author(s):    A. Yu   S. Socea   F. Fusco   M. Pellegrini   G. Galante   M. Busin     

Abstract Details

Purpose:

To report the outcomes of superficial anterior lamellar keratoplasty (SALK) for residual corneal scarring after limbal stem cell transplantation (LSCT) for ocular graft versus host disease (GVHD).

Setting:

Tertiary Care Referral Center (Ospedali Privati Forlì, “Villa Igea”)

Report of case or case series:

A 49-year old male presented with bilateral limbal stem cell deficiency secondary to ocular GVHD. One year after bilateral LSCT, visual rehabilitation remained limited on the left eye due to residual superficial corneal scarring with incomplete regression of corneal neovascularization and conjunctivalization. SALK was performed by dissection of the recipient cornea using a 130 μm microkeratome head and a “0” suction ring (Carriazo-Barraquer pivoting microkeratome; Moria, Antony, France). The donor cornea was then prepared by microkeratome-assisted dissection (90 μm, 9mm diameter), placed on top of the recipient bed and secured with a bandage contact lens. Suture fixation of the graft was not required. Two months postoperatively, Snellen visual acuity improved from 20/100 to 20/50. Vision was maintained over a 3-year follow-up with no signs of immunologic rejection or graft failure.

Conclusions/Take Home Message:

In severe ocular surface disease, visually significant corneal scarring may persist after ocular reconstruction through LSCT. By using a sutureless approach, SALK can successfully achieve early visual rehabilitation and minimize the risk of immunologic rejection and subsequent graft failure even in a “high risk” eye.