Preliminary results from the comparison of simple limbal epithelial transplantation with conjunctival limbal autologous transplantation in severe unilateral chronic ocular burns.

PURPOSE: To compare the safety, efficacy, and clinical outcomes of simple limbal epithelial transplantation (SLET) with conjunctival-limbal autologous transplantation (CLAU) in severe unilateral ocular chemical burns. MATERIALS AND METHODS: Twenty patients of unilateral chronic ocular burns with more than 270° limbal stem cell deficiency and a healthy fellow eye were divided into two groups - ten patients of Group A underwent SLET while ten patients of Group B were operated for CLAU. Patients were followed up for 6 months and assessed for a stable epithelialized ocular surface, extent of reduction in vascularization and forniceal reconstruction, improvement in corneal clarity and visual acuity. RESULTS: A stable epithelialized corneal surface was obtained in all patients, with a significant reduction in the mean clock hours of vascularization in both the groups (P < 0.001). The mean symblepharon score showed a statistically significant reduction from 1.80 ± 1.14 to 0.30 ± 0.63 in Group A and 1.70 ± 1.06 to 0.15 ± 0.24 in Group B at 6 months. Corneal clarity, as well as best-corrected visual acuity, showed a statistically significant improvement in both the groups. CONCLUSION: Both the procedures, SLET and CLAU, were equally effective in achieving a stable ocular surface, forniceal reconstruction, and regression of corneal vascularization. The requirement of minimal donor tissue in SLET makes it a preferred option over CLAU in cases of uniocular chronic ocular burns.

Results of Deep Anterior Lamellar Keratoplasty for Advanced Keratoconus in Children Less Than 18 Years.

PURPOSE: To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children with advanced keratoconus. DESIGN: Retrospective noncomparative interventional case series. METHODS: A retrospective analysis was conducted of 20 eyes of 16 patients who underwent deep anterior lamellar keratoplasty at a tertiary eye care center for advanced keratoconus. The main preoperative parameters measured were decimal uncorrected visual acuity (UCVA), decimal best-corrected visual acuity (BCVA), and average keratometry. The average keratometry was taken as an average of the flat and steep keratometric readings. The follow-up ranged from 24 to 105 months. The main outcome measures were UCVA, BCVA, steep and flat simulated keratometry, refraction, graft clarity, and complications. RESULTS: At the final follow-up, 18 patients had clear grafts in the visual axis area. Mean decimal UCVA changed from 0.06 ± 0.08 to 0.24 ± 0.09. Mean decimal BCVA changed from 0.12 ± 0.19 to 0.45 ± 0.24. The average keratometry decreased from 64.15 diopter (D) to 45.7 D after surgery. The complications noted in the patients were graft rejection (1), shield ulcers (2), graft infection (2), and interface vascularization (4). They were managed accordingly and only 1 patient needed penetrating keratoplasty. CONCLUSIONS: DALK is an effective therapeutic modality for the management of advanced keratoconus in children.

Role of corneal collagen cross-linking in pseudophakic bullous keratopathy: a clinicopathological study.

OBJECTIVE: To evaluate the clinical and histopathologic changes induced by collagen cross-linking (CXL) in pseudophakic bullous keratopathy (PBK). DESIGN: Randomized, prospective, interventional study. PARTICIPANTS: Twenty-four patients with PBK were included in the study. METHODS: Twenty-four patients with PBK underwent CXL followed by keratoplasty at 1 or 3 months. Twelve patients underwent penetrating keratoplasty 1 month after CXL (group A) and the remaining 12 patients underwent penetrating keratoplasty 3 months after CXL (group B). The main outcome measures were assessed at 1 week and 1 month for all patients and at 3 months for 12 patients only. The corneal buttons underwent histopathologic and immunofluorescence evaluation. MAIN OUTCOME MEASURES: Visual acuity, ocular discomfort (tearing, redness, pain), corneal haze, central corneal thickness, histopathologic evaluation, and immunofluorescent microscopy. RESULTS: Mean visual acuity showed a significant improvement after CXL, from 1.925 ± 0.173 before surgery to 1.75±0.296 at 1 month after surgery (P = 0.010), but deteriorated to 1.81 ± 0.23 at 3 months. Symptomatic relief after CXL was at a maximum at 1 month, with a worsening trend at 3 months. Eighteen patients showed a reduction in corneal haze 1 month after CXL. The effect was maintained in 9 of 12 patients at 3 months. The mean central corneal thickness decreased significantly from 846.46 ± 88.741 to 781.0 ± 98.788 µm at 1 month (P<0.01) after CXL, but increased to 805.08±136.06 µm at 3 months. Immunofluorescence microscopy revealed anterior stromal compaction in 7 of 12 patients (58.3%) in group A and in 5 of 12 patients (41.6%) in group B. Staining of keratocyte nuclei with 4',6-diaminido-2-phenylindole dihydrochloride (Molecular Probes, Carlsband, CA) revealed a relative uniform distribution throughout the stroma. CONCLUSIONS: Collagen cross-linking causes symptomatic relief and a decrease in central corneal thickness and anterior stromal compaction in PBK. However, the effect decreases with time and depends on disease severity.

Congenital accessory palpebral aperture--an addition to the spectrum of Delleman syndrome.

Delleman syndrome (oculocerebrocutaneous syndrome, MIM 164180) is characterized by orbital cysts, microphthalmia/anophthalmia, focal skin defects, skin appendages and multiple cerebral malformations. We herein describe a case of an 8-month-old male child with features suggestive of Delleman syndrome along with a rare congenital lid anomaly - an accessory palpebral aperture, not reported so far to the best of our knowledge.