COMBINED LIMBAL STEM CELL WITH AMNIOTIC MEMBRANE GRAFT TRANSPLANTATION FOR CHEMICAL BURN PATIENT

 The aim of this study is Evaluation role of combined limbal stem cell with amniotic membrane graft transplantation for chemical burn and thinning by assessment of healing of corneal epithelium, increased corneal thickness in case with corneal thinning by using slit lamp bio microscopy and anterior segment optical coherence tomography. Moreover, BCVA before and after procedure monitoring 

The patient underwent a biopsy of the limbus from the fellow eye; the biopsy material was cultivated on fibrin, a natural substrate that preserves holoclone-forming cells. (Mansoura ophthalmic center, Mansoura university, Egypt) The fibrin-cultured epithelial sheet has been grafted over the corneal and limbal region of the injured eye, where the receiving bed had been previously surgically prepared. A 360° peritomy was performedand the fibrovascular pannus was carefully removed. The fibrin-cultured epithelial sheet was placed on the prepared corneal wound bed, spanning the limbus about 2–3 mm with conjunctival ingrowth.The amniotic membrane was then sutured over the peripheral fibrin sheet and the whole cornea with in order to protect the border of the sheet and to help it adhere on the corneal surface 

A 50-year-old man with a 21-year history of chemical burn of the cornea caused by phosphoric acid in his left eye presented to our hospital with unilateral total LSCD, severe corneal conjunctivalization, cataract, and a corrected distance visual acuity (CDVA) limited to hand motion in the affected eye. After, combined limbal stem cell with amniotic membrane transplantation for the patient’s eye. The preoperative CDVA was limited to hand motion. Five days after the autologous LSC combined with amniotic membrane transplantation. The corneal surface became regular and transparent. Renewal of the corneal epithelium appeared within the first week after transplantation. Two weeks after surgery, the patient’s best corrected visual acuity was 20/50. After 30 days from transplantation, we observed almost complete corneal epithelium renewal, a regression of peripheral edema.

Several surgical procedures have been proposed for the treatment of chemical burn patients with LSCD in order to restore the limbal stem cell reservoir. After more than 50 years of trials, no consensus on guidelines for the management of this challenging condition has been reached. This is mainly due to heterogeneity of patient population, different follow-up periods, and outcomes, used in the clinical studies. In fact, while improvement of quality of life, visual acuity, or ocular surface may be considered a clinical success, to define a success of LSCT is necessary to combined it with amniotic membrane transplantation specifically in patients presented by Chemical burn with large corneal epithelial defect. Recently, umbilical cord patching is a promising alternative procedure which could be used in management of corneal surface reconstruction in acute chemical burn with corneal perforation.