Treatment of ocular surface burns with total limbal damage with in vivo corneal stem cell augmentation or induced puliripotent stem cells for total corneal surface and limbal reconstruction

Session Details

Session Title: Cornea Surgical II

Session Date/Time: Tuesday 13/09/2016 | 08:00-10:30

Paper Time: 09:50

Venue: Hall C2

First Author: : U.Erdem TURKEY

Co Author(s): :    S. Altun   A. Tas   S. Yildiz              

Abstract Details

Purpose:

We have been using a surgical method for severe ocular surface burns with the name of ‘HBOT (Hyperbaric oxygen treatment) and MMC assisted limbal minitransplantation’ for last 14 years . But, in certain cases we don’t perform limbal transplantation. Instead we augment trace amount of corneal ephitelial cells as Induced Puliripotent Stem Cells (IPSCs) source.We have explained this new surgical approach for the treatment of severe corneal-limbal burn and total limbal neovascularizations with (or without) very small area of intact epithelium in cornea.

Setting:

Limbal transplantation used for severe limbal stem cell insufficiency, but transplanted tissue is large and recovery time is long, allograft rejection is high. Current exvivo stem cell treatment options takes long time and economic burden. We described a new surgical technique without limbal transplantation and discuss the reasons for success.

Methods:

10 cases with severe corneal and total limbal neovascularization by alkaline burn with small epithelial island, treated with 'corneal stem cell augmentation method'. Neovascular membranes and symblepharons were removed, and smoothened with diamond burr including 2 mm of corneal limbus. Only the limited area of intact epithelium in corneal central or paracentral areas MMC for 1 min. Patients were underwent to HBOT therapy ( 2.4 ATA, %100 oxygen saturation, for 90 minutes) for 10 days. 1 case of acute ocular surface burn with total corneal and limbal burn treated with HBOT, 1mg/kg prednisolone and doxcycline 100 mg po.

Results:

8 eyes recovered epithelium in 14 days, in these eyes, mean Snellen BSCVA increase were 4.4 (± 1.5) lines. 2 eyes were recovered corneal epithelium in 30 days All central and paracentral neovascularizations disappeared in 2 months and remained avascular during last visit after surgery. 1 eye had successful keratoplasty surgery for central leucoma. No intraoperative complications have seen. Acute alcaline burn eye developed a limbal island at 22th day and resulted with total ocular surface recovery. No patient needed limbal transplantation.

Conclusions:

In vivo stem cell augmentation or induction of puliripotent stem cell is a safe and minimally invasive technique for the treatment of certain cases with the limited area of intact epithelium in cornea even in one millimeter diameter. These treatment method and surgical method are superior to all other treatment options in certain cases and does not need imbal transplantation or ex vivo stem cell interventions. This results also prove that corneal epithelium can act as a potential induced stem cell source to recover all corneal and limbal area.

Financial Disclosure:

NONE