[Outcomes of conjunctival-limbal autograft in unilateral total limbal stem cell deficiency]

To report the outcomes of conjunctival-limbal autograft [CLAU] in patients with unilateral total limbal stem cell deficiency [LSCD] emphasizing surgical problems, complications, and their management. In this prospective interventional case series, CLAU combined with amniotic membrane transplantation as a graft was performed on 26 patients with unilateral total LSCD due to chemical or thermal injuries. Penetrating keratoplasty [PKP] was performed on eyes with dense corneal opacification. Main outcome measures were visual acuity, corneal transparency and vascularization, and complications. Optical PKP was performed on 18 eyes. Best spectacle-corrected visual acuity [BCVA] was 2.28 +/- 0.45 LogMAR before CLAU which improved to 0.64 +/- 0.52 LogMAR and 0.35 +/- 0.13 LogMAR at final follow-up in eyes with and without PKP, respectively. Corneal transparency and vascularization, which were graded as 4+ before surgery, improved to a mean of 1.7 +/- 0.8 and 2.1 +/- 0.7 three months after surgery. Mean epithelial healing time was 8.8 +/- 4.1 [range 5 to 20] days. Longer healing occurred in 5 eyes due to small lenticules [n=2], exposure [n=2], and conjunctival encroachment [n=1]. Mean healing period for epithelial defects over PKP was 8.8 +/- 5.5 [range 4 to 14] days. Persistent epithelial defects occurred in 8 cases with cut lenticules [n=2], small-sized lenticules [n=2], and chronic exposure [n=4]. Lenticule-related complications were thick lenticules [n=4], conjunctival mantle encroachment [n=2], dislodging [n=4], progressive thinning [n=2], small size [n=3], and accidental trephination [n=2]. CLAU combined with AMT with or without PKP is effective in anatomical and visual rehabilitation of eyes with unilateral total LSCD. This procedure increases corneal transparency and decreases vascularization. The lenticules should be handled carefully in order to avoid most common lenticule-related complications

[Current approaches for management of post-penetrating keratoplasty astigmatism]

In addition to graft clarity, an acceptable refractive error is essential to consider a corneal transplant successful. The most common complication of penetrating keratoplasty [PK] is postkeratoplasty astigmatism which can result in decreased visual acuity, anisometropia, and mono-ocular diplopia. These complications can cause patient dissatisfaction, in spite of a successful transplant. Intraoperative measures to reduce post-PK astigmatism include round and central trephination with an appropriate size, evenly distributed suture tension, and perfect apposition of recipient and donor corneas. Suture manipulation in the early post operative period can effectively reduce astigmatism. If graft astigmatism is significant after complete suture removal and cannot be corrected using glasses or rigid gas-permeable contact lenses, further interventions such as relaxing incisions, compression sutures, laser refractive surgery, intrastromal corneal ring implants, wedge resection, and toric intraocular lens implantation can be considered. If these approaches fail to reduce astigmatism, then repeat PK becomes inevitable. A combination of the above mentioned approaches may be necessary to achieve an acceptable outcome

[Keratolimbal allograft in total limbal stem cell deficiency]

To investigate the outcomes of keratolimbal allograft [KLAL] for treatment of total limbal stem cell deficiency [LSCD]. Patients with total LSCD and adequate tear production were included. A total of 27 KLAL procedures were performed in 21 eyes of 20 patients with LSCD. Immunosuppression was achived using mycophenolate and cyclosporine. Main outcome measure was improvement in vision; in addition, KLAL survival and post operative complications were studied. Mean follow up period was 22.14 +/- 11.83 months [range 6-39]. Mean visual acuity improved from 2.53 +/- 0.21 to 1.49 +/- 0.77 LogMAR [P<0.0001]. Six KLALs never re-epithelialized and were considered as primary failures. Mean KLAL survival was 14.23 +/- 1.5 months. Graft survival rate was 61.9% at 1 year and 31% at 20 months. Complications included corneal ulcers in 6, glaucoma in 2 and scleral thining in 1 case. Keratolimbal allograft surgery is successful in the short term for visual rehabilitation of patients with total limbal stem cell deficiency

[Results of descemet`s stripping with endothelial keratoplasty [dsek] in patients with bullous keratopathy after cataract surgery]

To evaluate the anatomical and visual outcomes of Descemet`s stripping with endothelial keratoplasty [DSEK] in patients with bullous keratopathy after cataract surgery. The study was performed on 20 eyes of 20 patients [13 male, 7 female] with bullous keratopathy [pseudophakic=15, aphakic=5]. Donor lenticule was prepared using a micro keratome [n=12] or manual dissection [n=8]. Patients were excluded in case of extensive corneal scarring and/or vascularization. DSEK surgery was performed by removal of recipient endothelium and Descemet`s membrane, and replacement by the donor lenticule. Patients were followed at least for 6 months. Mean age at surgery was 64.6 +/- 6.7 years and mean follow up was 7.3 +/- 2.1 months. At final follow up 15 grafts were clear. Failure was seen in 5 cases. Visual acuity LogMAR was 1.96 +/- 0.38 before and 0.52 +/- 0.09 after the procedure [P<0.0001]. Mean topographic keratometry was 46.0 +/- 2.9 D before surgery which reached 44.4 +/- 1.7 D postoperatively [P=0.219]. Preoperative astigmatism was 2.5 +/- 1.7 D which decreased to 1.1 +/- 2.3 D at final follow up [P=0.229]. Mean pre- and postoperative surface regularity index [SRI] were 1.47 +/- 0.60 and 0.43 +/- 0.17, respectively [P=0.006]. No case of endothelial rejection was observed. DSEK surgery is an effective treatment modality in cases of bullous keratopathy after cataract surgery with acceptable anatomical and visual outcomes