Abstract
The study aims to evaluate the effect of allogeneic cultivated limbal epithelial cell sheet transplantation (CLET) in reconstructing conjunctival sac for severe symblepharon after chemical and thermal burns. A retrospective, non-comparative case series. Thirty-six eyes (36 patients) underwent CLET for severe symblepharon and conjunctival sac stenosis or atresia. Symblepharon was separated, and pseudopterygium was preserved to replace the palpebral conjunctiva. Allogeneic cultivated limbal epithelial cell sheet using human amniotic membrane as a carrier was transplanted into the recipient's eye to reconstruct the conjunctival sac. The effect of conjunctival sac reconstruction, eye and eyelid movement, ocular surface restitution, and symblepharon recurrence were analyzed after surgery. Symblepharon was completely relieved in 30 of the 36 eyes (83.3%) by a single surgical procedure, with fornix reconstruction, as well as free movement of eye globe and eyelids. Strip-like symblepharon remained in 6 eyes (16.7%) and was completely relieved after the second CLET. Twenty patients without visual function received prostheses 3 months after surgery and the other sixteen patients underwent different corneal transplantation for visual acuity improvement. During the follow-up period, no one had symblepharon recurrence. The transplantation of cultivated allogeneic limbal epithelial sheets offers an effective and safe alternative in the treatment of symblepharon and reconstruction of conjunctival sac in eyes with severe ocular burns, which lays the foundation for subsequent treatments.
Highlights
Severe chemical and thermal burns can injure the ocular surface
Further symblepharon separate on combined with second allogeneic cell sheet transplantation (CLET) was performed (Figure 2B), and a suitable prosthesis was implanted in the 20 patients who lost visual function (Figure 2C)
Autologous conjunctival transplantation was effective for mild symblepharon, but the application of the method is limited because autologous limbal epithelial cells cannot be removed too much from the fellow eye, or the fellow eye was involved in burns and can’t provide limbal epithelial cells
Summary
Severe chemical and thermal burns can injure the ocular surface. If the limbal and central epithelia are both absent, the neighboring conjunctival epithelial cells will invade the corneal surface, the surface will be covered with abnormal conjunctiva, called pseudopterygium. Amniotic membrane (AM) [1, 2], autologous nasal mucosa [3], oral mucous membrane [4], as well as cultivated oral mucous membrane [5] with or without a carrier, and autologous cultivated limbal epithelial cells with [6] or without [7] a carrier were used to reconstruct ocular surface Most of these methods cannot be used to treat or are ineffective to severe symblepharon in severe burns [8, 9], but limbal stem cell deficiency (LSCD) can. We aimed to report clinical results of allogeneic CLET in relieving symblepharon and reconstructing conjunctival sac after chemical and thermal burns
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