Graft Survival after Lamellar Keratoplasty without Limbal Stem Cell Transplantation in Patients Exposed to Chemical Warfare

Keratopathy is a common complication following exposure to chemical warfare, namely mustard gas. In recent years, a quest was undertaken to seek an effective and uncomplicated corneal transplantation method by ophthalmologists nationwide. In our study, we report our results following lamellar keratoplasty (LK) without limbal stem cell transplantation in patients with delayed-onset mustard gas keratopathy (DMGK).  Thirty-one eyes of 22 veterans with DMGK who underwent conventional LK were assessed. The presence of limbal stem cell deficiency (LSCD) was proven clinically as well as by impression cytology. The results were evaluated based on best spectacle-corrected visual acuity (BSCVA), refractive error (RE), corneal clarity, and corneal graft survival rate. The mean age of patients at the surgery was 52.93±5.8 years, and the mean follow-up was 36.25±20.65 months. The mean preoperative BSCVA was 1.67±0.32 logarithm of the minimal angle of resolution unit (Log MAR), significantly improved, reaching 0.32±0.22 Log MAR after surgery (p = 0.001). The mean preoperative spherical equivalent (SE) was 2.47±1.17 diopters, significantly increasing to 3.5±1.08 diopters after suture removal was complete (p = 0.001). Epithelial graft rejection occurred in 9.67% of eyes (3/31) and was treated successfully with topical eye drops. At the end of the follow-up period, no signs of graft rejection were found, but three eyes had mild central corneal opacity. According to the results of our study, LK without LSC transplantation can be successful in patients with DMGK because of partial rather than complete LSCD.