Limbal stem cell deficiency in paediatric age: which approach?
First Author: E.Lopes PORTUGAL
Co Author(s): V. Maduro J. Feijão N. Alves C. Mota D. Maleita E. Lopes
To describe the surgical approach and outcomes of two paediatric patients diagnosed with Limbal Stem Cells Deficiency (LSCD).
Ophthalmology Department - Cornea and Transplant Unit, Central Lisbon University Hospital Center.
A retrospective review of the surgical approach in two paediatric patients with LSCD. Patient one was a 7-year-old male with a LSCD in three quadrants of the left eye caused by a lime burn. Best-corrected visual acuity (BCVA) was counting fingers (CF). A conjunctival-limbal autograft (CLAU) plus amniotic membrane (AM) transplant were performed. Patient two was a 17-year-old male affected by bilateral atopic keratoconjunctivitis with LSCD and complete corneal conjunctivalization. BCVA was CF bilaterally. He was submitted to a living-related conjunctival–limbal allograft (lr-CLAL) followed by penetrating keratoplasty (PK) six months later.
At one-year follow-up, both patients maintained epithelium stability with good reepithelialization, no regression of corneal neovascular pannus, and improvement of stroma transparency. BCVA improved from CF to 20/30 in patient one and 20/50 in patient two.
Visual rehabilitation is crucial in paediatric patients with LCSD (patient one) to avoid amblyopia development. CLAU combined with AM transplant can restore the corneal surface phenotype and visual function in unilateral LSCD. Bilateral LSCD presents a different set of challenges due to the lack of autologous limbal stem cells. Lr-CLAL followed by PK presents itself as an alternative, albeit with poorer results.