Dual lamellar keratoplasty combined with phacoemulsification and intraocular Lens implantation in a case of severe chemical burn

PurposeTo present successful visual rehabilitation of a patient who suffered from a severe chemical burn by performing a new alternative surgical approach termed dual lamellar keratoplasty combined with phacoemulsification and intraocular lens implantation.MethodsA 45-year-old man with a history of caustic soda eye injury in his left eye leading to a limbal stem cell deficiency, persistent epithelial defect, corneal scarring, and progressive vision loss was admitted. No posterior segment alterations were noted. Once the ocular surface was stabilized, simple limbal epithelial transplantation was performed; however, deep corneal scarring, Descemet folds, and lens opacity were detected. Therefore, 6 months later, simultaneously Deep anterior lamellar keratoplasty (DALK) and Descemet stripping with automated endothelial keratoplasty (DSAEK), combined with cataract surgery was performed for visual rehabilitation.ResultsAfter 15 months of follow-up, anterior segment reconstruction was achieved, and visual acuity improved from hand motion to 0.5 LogMAR unit. No intraoperative or postoperative complications were noted.ConclusionThis new modified procedure seems to be efficacy and safe for visual rehabilitation avoiding open-sky surgery-related risks by combining DALK, DSAEK and cataract surgery in a case of severe ocular burn.