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

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

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.

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.

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