Cultivated limbal epithelial transplantation and penetrating keratoplasty postchemical injury: a 14-year follow-up

Shah, Ritu; Puranik, Charuta; Mohamed, Ashik; Sangwan, Veena

doi:10.1136/bcr-2016-217372

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…No epithelial issues were noted in our case of total LSCD demonstrating the efficacy of these smaller grafts. A few studies have reported inadequate epithelial stability with grafts involving <90 o of limbus while others have demonstrated good epithelialization with two clock-hour grafts [8] , [9] , [10] , [11] . Another added advantage of mini-CLAU is that the procedure may be attempted even in cases with partial LSCD in the donor eye, provided the residual limbus is at least 6 clock-hours.…”

Section: Discussionmentioning

confidence: 99%

Mini-conjunctival autograft combined with deep anterior lamellar keratoplasty for chronic sequelae of severe unilateral chemical burn: A case report

Kate

Basu

2021

International Journal of Surgery Case Reports

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Introduction and importance This case describes a novel technique combining a mini-conjunctival limbal autograft (CLAU) with a deep anterior lamellar keratoplasty (DALK) in a case of chemical injury sequelae. Case presentation A 19-year-old female presented with total limbal stem cell deficiency (LSCD) and a vascularized corneal scar in the visual axis of the left eye, 4 years following a chemical injury. In order to treat the LSCD and simultaneously visually rehabilitate the patient, a mini-CLAU with DALK was carried out. Two separate one clock-hour CLAUs were harvested from the right eye and secured in the left. The graft was clear in the initial postoperative period and maintained its clarity over 15 months of follow period with a visual acuity of 20/30 with scleral contact lenses. The mini-CLAUs sustained a stable and well epithelialized corneal surface during the same period. Clinical discussion The use of the mini-CLAUs instead of the traditional CLAU circumvents the complication of an iatrogenic LSCD in the donor eye as the size of the donor grafts is smaller (1–2 clock hours versus 6–8 clock hours). Despite the smaller size, these grafts are efficacious in maintaining a well epithelialized corneal surface even in cases of total LSCD. The autologous nature of the graft defers the need for immunosuppression and its peripheral location facilitates ease of the surgical technique when combined with a keratoplasty. Conclusion This novel single-staged procedure is an effective technique to reestablish a stable ocular surface and to visually rehabilitate cases of chronic chemical injury with good long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Mini-conjunctival autograft combined with deep anterior lamellar keratoplasty for chronic sequelae of severe unilateral chemical burn: A case report

Kate

Basu

2021

International Journal of Surgery Case Reports

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“…For a review of the specific complications of these procedures see Yin et al [64]. Penetrating keratoplasty (PKP) is frequently undertaken as a second procedure following LSC transplantation in order to replace deep scarred stroma, with the ultimate aim of restoring sight [65][66][67].…”

Section: Tissue Transplant Techniques: Conjunctival-limbal and Keratomentioning

confidence: 99%

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

2020

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Destruction of the limbus and depletion of limbal stem cells (LSCs), the adult progenitors of the corneal epithelium, leads to limbal stem cell deficiency (LSCD). LSCD is a rare, progressive ocular surface disorder which results in conjunctivalisation and neovascularisation of the corneal surface. Many strategies have been used in the treatment of LSCD, the common goal of which is to regenerate a self-renewing, transparent, and uniform epithelium on the corneal surface. The development of these techniques has frequently resulted from collaboration between stem cell translational scientists and ophthalmologists. Direct transplantation of autologous or allogeneic limbal tissue from a healthy donor eye is regarded by many as the technique of choice. Expansion of harvested LSCs in vitro allows smaller biopsies to be taken from the donor eye and is considered safer and more acceptable to patients. This technique may be utilised in unilateral cases (autologous) or bilateral cases (living related donor). Recently developed, simple limbal epithelial transplant (SLET) can be performed with equally small biopsies but does not require in vitro cell culture facilities. In the case of bilateral LSCD, where autologous limbal tissue is not available, autologous oral mucosa epithelium can be expanded in vitro and transplanted to the diseased eye. Data on long-term outcomes (over 5 years of follow-up) for many of these procedures is needed, and it remains unclear how they produce a self-renewing epithelium without recreating the vital stem cell niche. Bioengineering techniques offer the ability to recreate the physical characteristics of the stem cell niche, while induced pluripotent stem cells offer an unlimited supply of autologous LSCs. In vivo confocal microscopy and anterior segment OCT will complement impression cytology in the diagnosis, staging, and follow-up of LSCD. In this review we analyse recent advances in the pathology, diagnosis, and treatment of LSCD.

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“…This may be due to hypoxia, mechanical injury, or limbal stem cell deficiency [19,20]. Corneal transplantation, the most common solid tissue transplantation procedure, can cause corneal NV and subsequent LK via suture-induced inflammation and alloimmune responses [21,22]. Corneal NV can reduce graft survival after corneal transplant [23].…”

Section: Etiologymentioning

confidence: 99%

Lipid Keratopathy: A Review of Pathophysiology, Differential Diagnosis, and Management

et al. 2020

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Lipid keratopathy is a disease in which fat deposits accumulate in the cornea, leading to opacification and decrease of visual acuity. This condition can be idiopathic without signs of previous corneal disease or secondary to ocular or systemic diseases. Lipid keratopathy is usually associated with abnormal vascularization of the cornea, and the lipid classically deposits adjacent to these vessels. Treatment of this condition usually aims to eliminate or prevent abnormal vessel formation, and several modalities have been described. In this review we summarize the etiology, pathophysiology, and clinical presentation of lipid keratopathy and describe current and emerging treatment regimens.

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Cultivated limbal epithelial transplantation and penetrating keratoplasty postchemical injury: a 14-year follow-up

Cited by 5 publications

References 12 publications

Mini-conjunctival autograft combined with deep anterior lamellar keratoplasty for chronic sequelae of severe unilateral chemical burn: A case report

Mini-conjunctival autograft combined with deep anterior lamellar keratoplasty for chronic sequelae of severe unilateral chemical burn: A case report

Recent Advances in Stem Cell Therapy for Limbal Stem Cell Deficiency: A Narrative Review

Lipid Keratopathy: A Review of Pathophysiology, Differential Diagnosis, and Management

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