ABSTRACT
PURPOSE: To describe the early results of penetrating keratoplasty (PKP) in patients who had earlier received limbal transplantation (LT). METHODS: Prospective, non-comparative interventional case series comprising of four patients with limbal stem cell deficiency (LSCD) due to chemical injury (Cases 1, 2, 4) and xeroderma pigmentosum (Case 3). Cadaveric kerato-limbal allografts or living-related conjunctival-limbal allografts were done in four eyes followed by PKP for visual rehabilitation 3-4.5 months later. The following details were noted: demographics, primary aetiology, type of limbal transplant (cadaveric or living-related), immunosuppression, vision and ocular surface stability before and after LT and PKP, surgical complications and outcome of PKP. RESULTS: Three eyes received living-related conjunctival-limbal allotransplantation and one received cadaveric kerato-limbal allograft. Duration of follow up after PKP ranged from 4 to 11 months. Visual acuity improved in the early postoperative period in all patients but reduced in 2 due to endothelial rejection and after trans-scleral cyclophotocoagulation for medically uncontrolled glaucoma. The ocular surface remained stable in all patients. All patients were started on immunosuppression on the first postoperative day. This was continued till the last follow-up visit. Post-PKP complications were punctate epithelial keratopathy, corneal allograft rejection and secondary glaucoma (one patient each). CONCLUSION: Satisfactory visual rehabilitation is possible after PKP following LT without compromising ocular surface stability. However, a prolonged and close follow-up is warranted to avert complications.
Subject(s)
Adult , Burns, Chemical/surgery , Cadaver , Conjunctiva/transplantation , Eye Burns/chemically induced , Female , Humans , Keratoplasty, Penetrating , Limbus Corneae/surgery , Living Donors , Male , Prospective Studies , Stem Cell Transplantation , Transplantation, Homologous , Treatment Outcome , Xeroderma Pigmentosum/surgeryABSTRACT
During the period of study, 11 patients with 14 lesions of SCC of the skin of the face with Xeroderma Pigmentosum [XP] were seen and treated surgically. Evaluation and follow up of these patients showed that, skin lesions in mild to moderate cases of XP are better treated by local excision and skin grafting while severe cases of XP with or without clinically evident malignancy are preferably treated by early entire excision of facial skin and replacement by skin grafts taken from a nonex-posed area of the body
Subject(s)
Humans , Male , Female , Carcinoma, Squamous Cell , Xeroderma Pigmentosum/surgery , Facial Neoplasms/surgeryABSTRACT
Os autores apresentam um caso clínico de xeroderma pigmentoso, doença muito rara, de caráter autossômico recessivo, multissistêmica, degenerativa e progressiva. É feita uma revisao da literatura e analisados os aspectos epidemiológicos e as diferentes formas clínicas. Discutem-se as formas de tratamento e os resultados histopatológicos. O caso clínico é descrito e documentado; o plano terapêutico adotado foi de ressecçao de toda a pele facial, para retirada de áreas afetadas por lesoes tumorais e de pele com alto potencial de malignizaçao. Estas regioes foram auto-enxertadas com pele de média espessura, respeitando-se as unidades estéticas da face; a área doadora escolhida foi a regiao femoral por tratar-se de pele pouco exposta aos raios ultra-violeta. O material foi enviado a estudo histopatológico. O resultado histopatológico confirmou o diagnóstico clínico. É apresentada a evoluçao do paciente após seis meses da intervençao cirúrgica. Enfatiza-se neste trabalho a importância da orientaçao dada aos pacientes portadores desta doença, especificamente a nao exposiçao à luz solar. Por fim, discute-se a abordagem multidisciplinar a que estes pacientes devem se submeter, a fim de prevenir e tratar precocemente as lesoes tumorais, obtendo-se assim um melhor prognóstico.