Abstract
A 9 year old girl presented with decreased vision and whiteness on the cornea 9 months after a chemical injury induced after burst chuna packet. Total unilateral limbal stem cell deficiency was managed by performing single stage simple limbal stem cell transplantation (SLET) combined with large graft penetrating keratoplasty, cataract surgery and posterior chamber intra-ocular lens implantation. She regained 20/80 vision at 3 months. The ocular surface was stable and the cornea was clear. Further visual gain was limited due to anterior capsular opacification and amblyopia. Treatment of unilateral corneal blindness following ocular surface burns, once considered incurable, gives rewarding results. Early visual rehabilitation is essential to prevent amblyopia.
Highlights
A 9 year old girl presented 9 months after chemical injury with lime powder from a burst ‘chuna’ packet, with complaints of painless decrease in vision for past 6 months
Sangwan et al[4] have proposed a novel simplified technique of limbal transplantation, in-vivo cultivation of autologous limbal epithelial cells (Simple Limbal epithelial Transplantation-SLET), which combines the advantages of conjunctival limbal autografting (CLAU)[5] and cultivated limbal epithelial transplantation (CLET)[6] by being a single-stage, affordable procedure which utilizes a minimal donor tissue and does not need a stem cell laboratory for cultivation of limbal epithelial cells
A two-stage approach of performing autologous CLET followed by penetrating keratoplasty (PK) has been found to be better in successfully restoring the ocular surface stability and vision in eyes with unilateral limbal stem cell deficiency (LSCD) due to ocular burns.[8]
Summary
A 9 year old girl presented 9 months after chemical injury with lime powder from a burst ‘chuna’ packet, with complaints of painless decrease in vision for past 6 months. Her clinical records revealed that she had undergone a surgical procedure earlier which had a corneal perforation and cyanacrylate glue application. Ultrasound biomicroscopy (UBM) was done to assess the anterior segment which showed open angles all around. It revealed iris adhesions with the cornea centrally, evidence of the perforation that had happened earlier when cyanoacrylate glue had been applied (Figure 2). We performed a single stage surgery which included resection of the conjunctival pannus, penetrating keratoplasty, extracapsular cataract surgery with intra-
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