8.2  Surgical Treatment of Eyelid Burns

rejection have been noticed. The big diameter LK provides LSC and enables to get a steady reepithelialized ocular surface. It is recommended when the deep layers of the cornea have been spared by the burn [50].

after transplantation of cultivated epithelial limbal cells is good [54].

8.1.8.5  The Keratoplasty with Architectonic Goal

The keratoplasty with architectonic goal aims to fulfill the loss of corneal substance, which is the origin of a perforation of the eyeball. It is rarely recommended and, most of the time, it is practiced in emergency. It is always necessary to search for an LSC deficiency. The type of keratoplasty to practice depends on the size, the depth, and the site of the lesion. It may be a central TK, an eccentric TK, a central or peripheral DLK.

8.1.9  The Transplantation of Cultivated

Limbal Epithelial Cells

The autotransplantation of cultivated limbal epithelial cells to an amniotic membrane is a recent technique. It has been developed by Tsai in Taiwan [51]. A 1 × 2 mm fragment of limbal epithelium is sampled from the safe eye. It is then cultivated for 3 weeks on an amniotic membrane. The epithelial tissue is grafted with the amniotic membrane to the recipient cornea after excision of the fibrovascular tissue. The same technique of culture is used by Shimazaki for allografts. He records the results of 13 cases of limbal epithelial cell allografts, 2 of which have been practiced after sequelae of chemical burns with complete limbal deficiency. The global rate of epithelialization is 46.2%. For the two cases of burns of the research, there is a resulting epithelialization of corneal type after 16 and 22 days, and the visual acuity has clearly improved [52]. Nakamura describes the case of a severe burn on which a transplantation of cultivated epithelial limbal cells was practiced 4 years after the trauma. Two days after the transplantation, the cornea is cicatrized and covered by limbal cells. After 8 months, the condition of the corneal surface is stable and the visual acuity is excellent [53]. Sangwan records 15 cases of TK practiced after transplantation of limbal epithelial cells. After 8 months, the cicatrization is steady for 93% patients and the visual acuity is over 3/10 in eight cases. For this author, the short-term prognosis of a TK

8.1.10  Keratoprosthesis

Keratoprosthesis is the last surgical recourse for the cases of bilateral corneal cecity, when transfixion keratoplasties and transplantations of limbal stem cells can no more be achieved. Keratoprosthesis are made of two elements: a central transparent optic part and a support that provides its fixing onto the cornea. The support can either be synthetic or biologic. Developed by Strampelli in the 1960s, the odonto keratoprosthesis uses the root of a tooth. Although it is uneasy to set up, it is still up to date because its results are sometimes encouraging [55]. More recently, fluorocarbons have been used [56]. The structure of these polymers is similar to a micro fishnet that can be colonized by the corneal stroma. There are numerous types of keratoprosthesis, but none of them has proved to be better than the others. Complications are frequent and dominated by expulsion. This is tragic and irreversible because it is coupled with a necrosis of the cornea, which is followed by an atrophy of the eyeball. The occurrence of a retroprosthetic membrane seems to be more frequent in the cases of burns. Among other complications, there are severe ocular hypertony, endophthalmies, necrosis of the adjacent tissues, retinal detachment, eyeball atrophy. Among 17 cases of keratoprosthesis operated after chemical burns, the visual acuity is lower than 1/10 for 36% after 2 years and for 75% cases after 5 years [57].

8.2  Surgical Treatment of Eyelid Burns

The eyelid skin is the thinnest of the whole human body. Hypodermis has no lipidic structures, replaced with a more or less fibrous subcutaneous fascia. 3rd-grade burns damage the derma and the orbicularis occuli. Deep 2nd-grade and 3rd-grade burns cause major retractions with palpebral eversion and permanent nonocclusion. These phenomena of retraction of the skin and orbicular level are more important in the cases of extended facial burns, in which there is also the retraction of the facial tissues surrounding the eyelids.