Evaluation of therapeutic deep anterior lamellar keratoplasty in acute ocular chemical burns

PURPOSE. To evaluate the role of deep anterior lamellar keratoplasty (DALK) in acute ocular chemical burns. METHODS. The study was conducted in 50 eyes of 50 patients (24 male, 26 female) with average age of 38.3 +/- 14.3 years. DALK in 5 eyes (10%), DALK with quadrant conjunctivo-limbal graft in 25 eyes (50%), and DALK with amniotic membrane in 20 eyes (40%) were performed along with conventional medical therapy. Controls who were matched in all respects (50 eyes) were given medical therapy only as they refused surgical intervention. RESULTS. Follow-up of cases ranged from 6 to 48 months (mean 21.5 +/- 14.18 months). Forty-three eyes (86%) could be restored with clear cornea as compared to 6% in control group. The visual acuity improvement was seen in 100% with good score (0.49 +/- 1.46) in DALK group as compared to 18% with low score (0.03 +/- 0.01) in control group (p<0.0001). Visual acuity improvement in DALK was 6/12 in 19 eyes (38%), 6/24 in 28 eyes (56%), and 6/36 in 3 eyes (6%) but was 3/60-6/60 in 6 eyes (12%) and finger counting only in 3 eyes (6%) in control group. Eyes with advanced grade II and grade III showed better improvement than those with burns of grade IV (p<0.05). The discomfort was relieved and epithelial healing was achieved immediately in DALK as compared to a prolonged course in control group (p<0.0001). Vascularization presented in 38% in DALK with least score (0.13+0.15) as compared to 100% in control group with high score (2.8 +/- 0.30). Perforation of cornea was seen only in 2 cases (4%) in DALK with low score (0.03 +/- 0.10) as compared to 88% in control group (1.33 +/- 0.20). Symblepharon was seen in 2% in DALK group as compared to 62% in control group. CONCLUSIONS. DALK with and without conjunctival or amniotic membrane transplantation is an effective technique in restoring the integrity of the eye with an excellent graft transparency in 86% and improvement in visual acuity in 100% of the acute chemical burns. (Eur J Ophthalmol 2008; 18: 517-28)