Annular Conjunctival Autograft (ACAU): Modified Technique for Ocular Surface Reconstruction in Unilateral Chemical...

Chemical burns due to calcium hydroxide are common among all ages in the Indian subcontinent causing corneal blindness and disfigured eyes. Here, we applied a modified surgical procedure to assess the surgical outcome of a unilateral chemical burn complicated by limbal stem cell deficiency and symblepharon, which was managed by an annular conjunctival autograft from the other eye. This prospective, non-randomized, non-controlled quasi-study of 37 patients was conducted in a tertiary care eye hospital in Bangladesh from January 2015 to December 2018. Inclusion criteria were unilateral old chemical burn with total limbal stem cell deficiency and symblepharon with vision up to the perception of light. Exclusion criteria were bilateral cases, glaucoma due to a secondary cause, any pathology in the retina and optic nerve, and aqueous deficiency. All patients followed up for 24 months. The age range and mean age were 02 to 45 years and 17.14±10.92 years respectively. Fifty-four percent were at or below 16 years. Delay in presentation after burn to ophthalmologist varied from 6-156 months. Preoperative visual acuity was perception of light to 6/36 and postoperative was hand movement to 6/12. Preoperative corneal clarity defined by iris detail and pre-operatively it was clear iris detail at 2.7%, hazy iris detail at 24.3%, and no iris detail at 72.97%. Post-operatively it improved to 35.13%, 62.16%, and 2.7% respectively. Eighty-one percent of patients were happy with their post-operative outcome. In 24 months of follow up symblepharon or conjunctivalization of the cornea did not occur. Fellow eyes showed no limbal stem cell deficiency. The surgical technique of ACAU may be an option not only for the treatment of complicated old chemical burns associated with limbal stem cell deficiency and symblepharon but also can preventing it.