lamellar keratoplasty for management of mustard gas keratitis

purpose: to report the outcomes of manual lamellar keratoplasty (lkp) in patients with delayed-onset mustard gas keratitis (mgk) and compare visual outcomes between subgroups with simultaneous or sequential klal and lkp. methods: in this retrospective, interventional study, 52 eyes of 37 male survivors of chemical warfare with mgk who underwent lkp were included. the results were evaluated with respect to best spectacle-corrected visual acuity (bscva), refractive error, keratometric readings and graft clarity. eyes with sequential versus simultaneous surgery were compared in terms of bscva, refraction, corneal graft surface stability, and stem cell and corneal graft survival rates. results: mean patient age at the time of surgery was 43.4±8.2 (36-48) years, and mean follow-up period was 41.4±19.6 (19-107) months. mean preoperative bscva was 0.51±0.48 logmar, which increased to 0.33±0.18 logmar (p=0.03). mean preoperative spherical equivalent refractive error was -2.40±1.5 diopters (d), which remained unchanged postoperatively (-1.52±3.7 d, p=0.77). no significant difference between sequential and simultaneous surgery subgroups was observed in bscva, refraction, keratometry readings, or corneal graft survival (90.3% and 89.9%, respectively; p=0.68). however, the simultaneous group had statistically better stem cell survival. conclusion: lkp can effectively improve bscva in mgk. the simultaneous approach is superior to sequential surgery when both stem cell and corneal transplantation are indicated.