Several steps necessary in treatment of severely damaged ocular surfaces

Ocular surface reconstruction using expanded limbal stem cell culture combined with penetrating keratoplasty can restore good vision even in some cases with severe acid burns, said Merce Morral MD, Barcelona, Spain at the 19th Winter Meeting of the ESCRS in Istanbul. She presented a case study involving a 31-year-old patient who had severe acid-burn in both eyes. His right eye regained a visual acuity of 20/20 following several reconstructive surgeries. However, his left eye had a vision of only 20/400 due to severe limbal cell insufficiency. Dr Morral and her associates therefore decided to treat the eye in a two-stage procedure. The first stage involved repairing the epithelial defect using tissue-culture expansion of limbal stem cells grown on fibrin gel followed by a penetrating keratoplasty. They obtained the stem cells for tissue expansion from the patient’s right eye and allowed to grow for three weeks. Prior to placing the tissue in the patient’s limbal stem cell deficient left eye they removed all of the fibrovascular growth from the ocular surface and then placed the graft over the denuded cornea. To assist healing they placed amniotic membrane on top of the graft and a bandage contact lens on top of that. One week postoperatively the epithelium had regenerated and the eye was calm. However, vision remained pore because of corneal scarring. The patient subsequently underwent a penetrating keratoplasty and at one year’s follow-up, the eye had a visual acuity of 20/25 “Eyes with total limbal stem cell deficiency require several steps to restore good visual acuity,†Dr Morral added.