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Do we really need limbal transplantation for severe ocular surface burns with total limbal neovascularisation ? A new surgical Method: In-vivo 'corneal stem cell augmentation'

Poster Details

First Author: U.Erdem TURKEY

Co Author(s):    S. Altun   S. Yildiz           

Abstract Details

Purpose:

We have been using a new surgical approach for severe ocular surface burns. With the name of ‘HBOT (Hyperbaric oxygen treatment) and MMC assisted limbal minitransplantation’ for last 13 years. In certain cases with the limited area of intact epithelium in corneal central or paracentral areas even in one millimeter diameter we don’t use a limbal transplntation. We can augment this area to cover all corneal limbal surface. We have explained this new surgical approach for the treatment of severe corneal-limbal burn and total limbal neovascularizations with the limited area of intact epithelium in corneal central or paracentral areas.

Setting:

Case series of 7 cases with severe corneal and total limbal neovascularization due to alkaline burn with the limited area of intact corneal epithelial island treated with 'corneal stem cell augmentation method'. Cornea & Refractive Surgery Dept. of Eye Clinics of Gülhane Military Medical Academy& Hospitals

Methods:

In 7 eyes,neovascular membranes and symblepharons were removed, corneal limbus exposed to 0.01mg/ml MMC for 1 min, and 4x3 mm size autograft from the fellow eye or allografted (6 eyes). Patients were underwent to HBOT therapy ( 2.4 ATA, %100 oxygen saturation, for 90 minutes).

Results:

Limbal transplantation had been using for severe limbal stem cell insufficiency, and ocular surface neovascularizations but transplanted tissue is large and recovery time is long, graft survival is limited and allograft rejection is high. Current ex vivo stem cell treatment options is take long time and need economic burden. We described a new surgical technique without limbal transplantation using supportive effect of Mitomycin C HBO therapy for it’s supportive effect of corneal oxygen consumption and epithelial healing.

Conclusions:

In vivo stem cell augmentation is a safe and minimally invasive technique for the treatment of certain cases with the limited area of intact epithelium in corneal central or paracentral areas even in one millimeter diameter. This surgical method is superior to all other treatment options in certain cases and does not need imbal transplantation or ex vivo stem cell interventions. This method and results also prove that corneal epithelium can act as a potential stem cell source to recover all corneal and limbal area.

Financial Disclosure:

NONE

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