Successful deep anterior lamellar keratoplasty following multiple failed limbal transplantations for chronic ocular burns.

A 9-year-old girl with severe unilateral ocular surface disease due to limbal stem cell deficiency following chemical injury underwent autologous cultivated limbal epithelial transplantation (CLET) twice in her right eye that failed to improve the condition of the ocular surface. On both occasions, limbal biopsies were obtained from the unaffected left eye. Since further attempts at CLET were not considered to be safe, deep anterior lamellar keratoplasty (DALK) was performed instead. DALK was complicated by postoperative Descemet's membrane detachment, which was successfully treated. Two years post-DALK the patient had a clear graft, stable ocular surface and visual acuity of 20/80. The mechanism by which CLET allows a patient to repopulate the ocular surface is as yet unknown. This case highlights that although clinically little had changed following two failed CLET surgeries, some subclinical improvement must have taken place for a DALK to remain successful after 2 years.