Penetrating keratoplasty in combination with limbic transplantation in the rehabilitation of patients with total corneal leukomas of burn genesis

The paper gives the results of a follow-up of the clinical course and visual outcomes of penetrating keratoplasty (PK) in combination of corneal epithelial stem cell grafting (limbic transplantation (LT)) in 10 patients (10 eyes) in end-stage burn disease. For LT, autologous limbic grafts were used in 5 cases and allogenic ones were applied in 5 more cases. Visual outcomes were assessed in the periods of 2 months to 4 years and 3 months. A rather high visual acuity was obtained in the patients who had undergone PK in combination with autologous LT. The majority of patients with allogenic LT were observed to have a recurrence of keratoleukoma and less significant functional outcomes. Possible tissue incompatibility, followed by lysis of allogenic limbic grafts, and inadequate ocular surface moistening are considered to be main causes of recurrent corneal conjunctivalization. PK in combination with LT substantially increases the possibility of visual rehabilitation in patients with postburn total corneal leukomas. The use of autologous limbic grafts for these purposes is more effective as compared with that of allogenic ones.