Simple Limbal Epithelial Transplantation (Slet) From A Monozygotic Twin In A Severe Bilateral Chemical Burn: Case Report

This report describes the management of bilateral stem cell deficiency (LSCD) in a patient with bilateral chemical burn with simple limbal epithelial transplantation (SLET) performed using her monozygotic twin as a donor and the potencial advantage in this case, as systemic inmunosuppresants are not required.

 We present a case report of a 32 years old, female patient, with history of bilateral LSCD due to a chemical burn, treated at Bascom Palmer Eye Institute, Miami, Florida; with a simple limbal epithelial transplantation (SLET) using her monozygotic twin as her donor.

A 32-years-old presented with bilateral chemical burns with LSCD deficiency on the right eye stage IIB and on the left eye stage IA, according to the staging system of LSCD if the Global Consensus on the management of limbal stem cell deficiency. The patient present a superior symblepharon on the right eye with visual axis involvement. The central cornea in the left eye was clear, however it presented a limbal stem cell deficiency that could not permit obtaining stem cells for a SLET for the contralateral eye. The patient underwent a monozygotic twin SLET in the right eye to restore the ocular surface, no immunosupresion was required. During the follow up, patient present with fungal keratitis, cultured for Curvularia spp, after for three weeks she was treated with antifungal medication and with close follow up for risk of corneal perforation. Fortunately, once overcome the infection, the patient present a significant visual and quality of live improvement, with BCVA of 20/50 after six months follow up.

SLET from a monozygotic twin in this case, was a better alternative to treat this patient than allogeneic SLET, specially because no systemic inmunosuppresants were required as the donor was obtained from her monozygotic twin.
The outcome of SLET from a monozygotic twin in a patient with severe bilateral chemical burn have not been previously described.