A CASE OF OCULAR SURFACE RECONSTRUCTION IN A CHILD WITH UNILATERAL LIMBAL STEM CELL DEFICIENCY AND ENTROPION AFTER FIRECRACKER INJURY

To describe a clinical course of a pediatric patient treated by entropion repair and glueless simple limbal epithelium transplantation (G-SLET) for ocular surface reconstruction and preventing amblyopia development.

The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia

A 7-year-old girl was presented in the clinic with partial (5 hours/150 deg) unilateral limbal stem cell deficiency (LSCD) and lower eyelid entropion on left eye (LE) after an accidental firecracker injury in Dec 2019. Before the injury, she was emmetropic with UCVA 1.0 OU. At first, the entropion repair with oral mucosa grafting was done in the oculoplastic department. However, despite the success of the surgery and little involvement of the LE central cornea, the patient developed mixed astigmatism six months later. Her refraction was +0,5D for RE and -12.25D for LE and BCVA on LE decreased to 0,08 (decimal values). Anterior segment optical coherent tomography (AS-OCT) OS demonstrated progression of conjunctivalisation and subepithelial fibrosis to the central cornea as well as an irregular corneal epithelial map. G-SLET on LE was done with five limbal auto-transplants inserted into the corneal tunnels. During the first postop month, patient had an intensive irritation LE which gradually decreased on steroid and fourth-generation fluoroquinolone ointments. Additionally, occlusion therapy for LE was recommended for one hour per day for 3 months. At one month postop here BCVA on LE was 0.6 with SE +1.25D. The LE cornea was fully epithelized with light punctate fluorescein staining. The biopsy site on RE healed with a light scar and was surrounded with light local conjunctival hyperemia. At three-month postop UCVA and BCVA on LE were 0.4 and 0.7, respectively, with SE -0.25D. The cornea LE was fully epithelized and had no staining. An eyeglass was prescribed for ametropia correction for permanent use. At twelve-month postop (last appointment) UCVA and BCVA on LE were 0.4 and 0.7, respectively, with SE -0.625D. The cornea LE was fully epithelized and had no staining. AS-OCT LE demonstrated a normal cornea epithelial map and absence of subepithelial fibrosis in the central cornea. The biopsy site on RE at three- and twelve months postop was invariable. 

Partial LSCD, as a complication of burn eye injury, could induce corneal astigmatism and contribute to the development of amblyopia in children. G-SLET was effective in the elimination of conjunctivalization in the central cornea. Occlusion therapy after G-SLET promoted improvement in UCVA and BCVA in the injured eye.