To evaluate the mid-term outcome of penetrating keratoplasty (PKP) after cultivated oral mucosal epithelial transplantation (COMET) in patients with bilateral total limbal stem cell deficiency (LSCD) due to chemical burn.

In this prospective interventional nonrandomized case series, optical PKP was performed in patients with severe stromal opacity after successful COMET. Main outcome measures were stability of the ocular surface, visual acuity improvement and corneal graft survival.

Fourteen eyes of 14 patients with successful COMET were included. Time interval between PKP and COMET was 7.6±1.3 months (6-9 months). Mean follow-up period was 28.2 ± 8 months (14-40 months, median 30 months). Epithelial healing was complete after 7 days in all eyes. Thirteen eyes had stable ocular surface without epithelial defect at final examination. The corneal surface had been covered by a transparent epithelium without significant neovascularization. Persistent epithelial defect developed in one eye 3 months after PKP which was considered as graft failure. Best-corrected visual acuity increased from 2.67±0.08 LogMAR preoperatively to 0.64±0.27 LogMAR after PKP (P<.001). Endothelial rejection occurred in four patients and was successfully managed by systemic and topical steroids. Overall and rejection-free graft survival rates were 92.9 and 69.2%, respectively.

PKP after COMET is a successful procedure which can be used to restore visual function in cases with bilateral total LSCD associated with severe stromal opacity due to chemical burns.