Surgical Management of Limbal Stem Cell Deficiency Secondary to Chemical Ocular Burns

Abstract

ABSTRACT

OBJECTIVES: We reported results of surgical management of limbal stem cell deficiency secondary to chemical ocular burns. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients who had surgery with the diagnosis of limbal stem cell deficiency from chemical burns between January 2016 and January 2023. Patients with follow-up of more than 6 months were included. We recorded demographic properties, best-corrected visual acuity at preoperative and last visits, medical and surgical treatment modalities, and outcomes. RESULTS: Nineteen eyes of 13 patients (9 males, 4 females) were included; mean age was 35.7±14.2 years. Limbal stem cell deficiency was bilateral in 6 cases. Mean time from injury to medical treatment was 13.3 ± 8.1 months (range, 4-23 mo). Six patients had bilateral involvement: 3 received living-related conjunctival allograft transplant, and 3 received deceased donor keratolimbal allograft transplant. Seven cases had unilateral involvement, 4 of which underwent conjunctival limbal autograft transplant and 3 had simple limbal epithelial transplant. Mean postoperative follow-up was 25.8 ± 16.6 months (range, 5-42 mo). Corneal transplant was performed simultaneously in 4 patients and 1 and 2 years after limbal stem cell transplant in 5 other patients. At the last visit, 13 eyes (68.4%) had intact and stable ocular surfaces with clear central corneas. Mean best-corrected visual acuity increased from 1.65 ± 0.93 to 0.78 ± 0.65 logMAR at last visit (P < .001). CONCLUSIONS: Treatment and restoration of the ocular surface health are challenging in limbal stem cell deficiency due to chemical injury to the ocular surface. Living-related conjunctival allograft transplant and cadaveric keratolimbal allograft transplant are currently available surgical techniques in bilateral cases. Unilateral cases can be managed with newer techniques such as simple limbal epithelial transplant, allowing the in vivo expansion of limbal stem cells on an amniotic membrane transplant.