Surgical Management Of A Corneal Burn With Limbal Stem Cell Deficiency And Corneal Perforation

Management of chronic ocular disease after a chemical injury can cause major therapeutic challenges , and requires a multidisciplinary approach involving cornea, oculoplastic, and glaucoma specialists. The goal of these surgical interventions is to restore normal ocular surface anatomy and visual function. The goal of our case is to describe a staged surgical procedure for a severe chonic ocular burn with corneal perforation and limbal stem cell deficiency.

The patient is a 60 years old male  who was presented in our hospital with severe chronic ocular chemical burn in both eyes , after injury with chloridric acid.

We present the case of a patient with an accidental chemical ocular burn in both eyes with hydrochloric acid a year ago. He received a limbal cell graft 15 days after the accident , and he developped an important corneal thinning in the right eye. He underwent an amniotic membrane transplantation 5 months after the accident with no good results.

The ophtalmological exam of the patient found a visual acuity of counting fingers in both eyes , and a partial conjunctivalization of the cornea with a corneal perforation and an inferior corneal pannus in the right eye. The anterior segment OCT presents important corneal thinning in both eyes  and a central perforation in the right eye.

The patient was treated surgically by a corneal graft located in the perforation and a cauterization of the inferior pannus. The corneal graft is not a therapeutic act , however it will prevent the cornea  from necrosis and total limbal deficiency.

In cases of partial LSCD with opacification of the central cornea, primary PK or DALK may be adequate , however, keratoplasty can aggravate a compromised ocular surface with a borderline stem cell reserve in some cases. Staged procedures are preferred to stabilize the ocular surface , and regenerate good corneal vascularization ,  before proceeding with keratoplasty.