Posters

A potential new application of SLET surgery in the treatment of complicated neurotrophic corneal ulcers: a case report

Poster Details

First Author: M. Srur SPAIN

Co Author(s): M. Srur   F. Mellado   C. Carranza   F. Vega   C. Gutierrez   S. Finianos     

Abstract Details

Purpose:

To present the treatment of a patient with a complicated neurotrophic corneal ulcer, by using a surgical procedure normally applied in the treatment of severe ocular surface defects with limbal stem cell deficiency

Setting:

In Fundacion Oftalmologica Los Andes Clinic (Santiago, Chile), we attended a 27-year-old male patient with history of Lasik, who was operated from a posterior acoustic nerve neuroma of the right side complicated by a postoperative facial nerve palsy, and develops a Neurotrophic Corneal Ulcer of the Right Eye (RE).

Methods:

At the beginning, we measured the Best Corrected Visual Acuity (BCVA), Refraction, intraocular pressure, Biomicroscopiy (BMC), ophthalmic fundus exploration, and corneal esthesiometry. BCVA and BMC were made in every control. Treatment started with autologous serum and Zymar®, after one month without improvement we added Lacrilube® and Cacicol® one drop per week. After one month an infectious appearance infiltrate was developed (cultures were negative), adding treatment with Amikacin 1.5% and Cefazolin 5%. At the end, Simple Limbal Epithelial Transplantation (SLET) with stem cells of the contralateral eye and double amniotic membrane graft, sealed with a tissue adhesive (Beriplast®), was achieved

Results:

After Lasik surgery the patient had achieved a 20/20p BCVA in both eyes. After the neuroma surgery he developed a 6 mm paracentral corneal ulcer in the RE, BCVA went down to hand movement, the RE esthesiometry was diminished, and the rest of the exploration was normal. He didn’t respond to autologous serum, worsened the inflammatory reaction after Lacrilube®, Zymar® and Cacicol® which got better with amikacin and cefazolin, but the ulcer didn’t heal. After two months of the surgery, epithelization is almost complete, there is a paracentral reepithelization line of 0.5 mm and his BCVA is 0.2.

Conclusions:

SLET surgery is a new procedure used in the treatment of severe ocular surface defects with limbal stem cell deficiency, with successful outcomes. The use of this procedure in other ocular surface pathology hasn’t been investigated until today. The use of limbal cell with the potential to regenerate epithelium could be a useful weapon in the treatment of chronic corneal ulcers and may help reduce the visual sequels do to corneal scarring. Further studies are needed to establish conclusive results, but we think this could be an effective technique and a reasonable alternative in these cases

Financial Disclosure:

None