Fig. 3

External eye photographs of Patient 2. A 42-year-old man suffered from severe alkaline burn. Extensive pannus ingrowth, entropion and symblepharon were noted (A). Conjunctivo-limbal autografting was not successful, and the cornea remained severely inflamed with a persistent epithelial defect, which evolved to become a perforated ulcer (B). The ulcer finally healed, but the cornea was covered by dense blood vessels and granulation tissue, and his vision was only light perception (C). After COMET, the cornea was well-epithelialized, and there was no single episode of epithelial defect (D, postop one month). The cornea was essentially avascular except in the temporo-upper quadrant (E, postop 6 months). Six months after COMET, penetrating keratoplasty was performed (F, photo taken 3 months postop). Two years after COMET, the graft was clear. G The graft remained clear up to post-COMET 4 years, and his best corrected vision remained above 20/120 (H). In the lower cornea and limbus, characteristic coarse fluorescein staining confirmed the presence of OMECs (I, margin indicated by arrows)