In-vivo corneal stem cell augmentation =1 mm² corneal surface cells is enough for ocular surface recovery: we do not need limbal transplantation for all severe ocular surface burns with total limbal insufficiency

Session Details

Session Title: Cornea: Surgical II

Session Date/Time: Tuesday 08/09/2015 | 14:00-16:00

Paper Time: 15:54

Venue: Room 11

First Author: : U.Erdem TURKEY

Co Author(s): :    S. Altun   U. Yolcu   A. Ilhan   S. Yildiz           

Abstract Details

Purpose:

We have been using a new surgical approach for severe ocular surface burns. With the name of ‘HBOT (Hyperbaric oxygen treatment) and MMC assisted limbal minitransplantation' for last 13 years. In certain cases with the limited area of intact epithelium in corneal central or paracentral areas even in one millimeter diameter we don't use a limbal transplantation. We can augment this area to cover all corneal limbal surface. We have explained this new surgical approach for the treatment of severe corneal-limbal burn and total limbal neovascularizations with very small area of intact epithelium in corneal central or paracentral areas.

Setting:

Limbal transplantation for severe limbal stem cell insufficiency, and ocular surface neovascularizations had been using 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. Gulhane Military Medical Academy,Turkey

Methods:

8 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.

Results:

6 eyes recovered epithelium in 10 days, in these eyes, mean Snellen BSCVA increase were 4.2 (± 1.3) lines. 2 eyes were recovered corneal epithelium in 30 days with 2 lines of Snellen VA increase. All central and paracentral neovascularizations disappeared in 2 months and remained avascular during last visit after surgery. 1 eye had successful keratoplasti surgery for central leucoma. No intraoperative complication have seen. No patient needed limbal transplantation.

Conclusions:

In vivo stem cell augmentation is a safe and minimally invasive technique for the treatment of certain cases with the limited area of intact epithelium in corneal central or paracentral areas even in one millimeter diameter. This surgical method is 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 stem cell source to recover all corneal and limbal area.

Financial Interest:

NONE