Abstract
Purpose: To evaluate the long term results of limbal transplantation (LT) in patients with unilateral total limbal stem cell deficiency (LSCD) after chemical injury. Methods: The study includes 22 eyes of 22 consecutive patients (20 males and 2 females) who presented with total LSCD after unilateral chemical burns and underwent Limbal transplantation (LT) in the Cornea Service of the Department of Ophthalmology at the Heraklion University Hospital in Crete during the period from 1997 to 2014. All 22 cases underwent Conjunctival Limbal autogaft (CLAU) while in 14 surgeries it was combined with amniotic membrane transplantation (AMT). A second stage penetrating keratoplasty (PKP) was performed in 11 cases for visual rehabilitation. The healing time, the changes in VA and the stability of epithelial ocular surface integrity were looked for. Results: One case failed within 3 months of surgery, while the rest 21 eyes after CLAU maintained ocular surface epithelial integrity during the follow up period (7.8 ± 3.5 years), and showed improvement partially or totally in corneal neovascularization, symblepharon and ocular motility. The mean corneal healing time was 17 days, while visual acuity either showed statistically significant improvement in 18 eyes, with CLAU alone or followed by PKP. No significant difference in the surgical outcome was observed between AMT and none AMT cases. Conclusions: Conjunctival limbal autografts for limbal deficiency after unilateral chemical burn showed long term success and stability, in 21 out of 22 eyes, whether combined or not with amniotic membrane transplantation
Highlights
Chemical injuries range in severity from trivial to potentially blinding with alkali burns to be more common and more dangerous than acid burns
Many studies report that limbal transplantation is an effective and safe procedure for the treatment of visual impairment or non-healing corneal epithelium due to limbal stem cell deficiency (LSCD) [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]
Autologous conjunctival limbal graft is transplanted from the healthy eye, while in bilateral cases allografts are used from living related donors or cadaver donors
Summary
Chemical injuries range in severity from trivial to potentially blinding with alkali burns to be more common and more dangerous than acid burns. Many studies report that limbal transplantation is an effective and safe procedure for the treatment of visual impairment or non-healing corneal epithelium due to LSCD [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. Both acute and chronic stage chemical injuries have been found to benefit from LT. Amniotic membrane transplantation (AMT) [6,7,14] can be used as an adjunct to CLAU or Limbal allograft (LAL) in order to promote epithelialization of the ocular surface, inhibit as much as possible fibrovascular proliferation and improve corneal clarity or to prepare corneal surface for future penetrating keratoplasty (PKP) [15,16,22]
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