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Keratoplasty after Mustard Gas Injury: Histology and Clinical Outcome
Richter M. N., Bechrakis N. E., Wachtlin J., Hoffmann F.
Augenklinik, Klinikum Benjamin Franklin, Freie Universität Berlin
Purpose: Ocular injury by mustard gas can lead to severe skin and eye damage with delayed course. We report the corneal histology and follow-up after keratoplasty of a patient with conjunctival and corneal mustard gas injury during the Iran/Irak war in 1988.
Method: The patient presented in our clinic in 1999 with recurrent extremly painful corneal inflammation. Despite therapy with ocular lubricants, therapeutic contact lenses and steroid eyedrops the lesions were progressive with vascularisation, necrosis and calcification more extended in the left cornea. In December 2001 a penetrating keratoplasty was performed on the left eye. The preoperative visual acuity was handmovements. In July 2002 an autorotation keratoplasty was performed on the right eye to move scarring into the center of the cornea for a later keratoplasty.
Results: The situation on the left eye has been stable with a visual acuity of 0,4 since the operation, and the patient was immediately painfree. Histology of the cornea revealed a very thin epithelium with subepithelial calcification and bullae. Bowmans layer was interrupted and only partially present. The stroma contained multiple necrotic cells, was vascularized and cellular infiltratated as a sign of chronic inflammation. The left eye has remained painful despite denervation of the cornea after the autorotation keratoplasty.
Conclusions: Mustard gas is a lipophilic, very cytotoxic and mutagenic agent which penetrates rapidly through tissue. Even though in our case the contact with the agent was long ago the damage on the eye continued to be progressive. There has been not much experience with corneal transplanation after mustard gas injury. Succesfull healing seems only possible after complete removal of the necrotic material.
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