Conjunctival transplantation as an alternative to keratoplasty

Rehabilitation of the ocular surface is frequently desired following severe chemical and thermal injury. While keratoplasty, both lamellar and penetrating, has been the usual mode of therapy, chronic healing deficits and graft rejections as a result of heavy vascularization often lead to an unsatisfactory result. In unilateral injury, conjunctival transplantation from the opposite, uninvolved eye offers an alternative therapy which avoids both intraocular surgery and the introduction of immunologically foreign tissue. Seven of ten cases of unilateral chemical or thermal injury showed marked reduction in vascularization and scarring following conjunctival transplantation. The characteristic early vascularization of the peripheral conjunctival grafts showed marked regression one to four months postoperatively. At the same time, the central cornea, whose superficial vessels and scarring were removed by keratectomy, showed reepithelialization and smoothing, without attendant vascularization. Three cases were optical failures partially as a result of deep scarring that could not be adequately excised with keratectomy. Preoperative evaluation must be directed primarily toward evaluation of the corneal thickness and the extent of deep vascularization to select those patients most likely to be improved by conjunctival transplantation.