The Ophthalmology Unit,  Universiti Malaysia Sarawak (UNIMAS), Kuching, Sarawak.
	The Ophthalmology Department, Sarawak General Hospital, Kuching, Sarawak, East Malaysia.

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Corneal graft and cataract surgery in stem cell deficiency

Photo by Professor Chua Chung Nen

This woman has bilateral congenital stem cell deficiency in both eyes (see also the page under contact lens staining). She underwent left superficial kerectomy and amniotic membrane graft 12 months ago to clear the cornea of neovascularization (at the time the vision was hand movement). The cornea was briefly cleared of blood vessels but reneovascularization occured 4 months later despite the use of topical steroid. Subconjunctival avastin and triamcelonone were considered but not given as the neovascuarilization was too extensive and unlikely to respond to either. Her vision gradually decreased over the last 6 months to light perception contributed partly by a mature cataract. Her other eye was light perception vision due to extensive corneal neovascularization and calcification. After discussing with the patient, she underwent superficial kerectomy with conjunctival recession,  left penetrating keratoplasty, open sky ECCE+IOL and amniotic membrane graft. The amniotic membrane was stabilized by the application of a bandage contact lens.

Left stem cell deficiency with neovascularization taken 14 months earlier.

Amniotic membrane graft after superficial kerectomy 12 months ago.

Reneovascularization of the cornea with mature cataract. Picture taken 2 weeks before penetrating keratoplasty.

Appearance of the eye 1 day after conjunctiva recession, superficial kerectomy, penetrating

keratoplasty, ECCE+IOL and amniotic membrane graft.

The vision improves slightly to hand movement after the operation. The reduced vision is partly

due to the amniotic membrane graft. It is uncertain if the cornea will remain clear for long.

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