Cornea Cases

Title:

Simple limbal epithelial transplant(SLET): a novel treatment in a case of Limbal stem cell deficiency(LSCD) due to chemical-injury

Case Report Details

First Author: A.Morya INDIA

Co Author(s):                        

Abstract Details

Purpose:

To assess the most simple and economical surgical technique of SLET in the management of chemical injury(lime-instillation) leading to LSCD.Improvement in visual recovery and decrease in signs and symptoms like pain, photophobia , corneal haze and lacrimation were clinically noted. Also the viability of a very cost -effective surgical technique of autologous limbal - stem cell over very costly cultured stem - cell transplant in developing countries and in a tertiary eye care centre.

Setting:

Under general - anaesthesia(GA) autologous conjunctival limbal graft was retrieved from right eye(RE) and transplanted in lime - injured LSCD left - eye (LE)with the help of fresh Amniotic membrane graft(AMG) after removal of pannus in a tertiary eye care centre of Western Rajasthan, India.

Report of case or case series:

A 11 year old Male came with complaint of sudden onset and gradually progressive painful decrease of vision in LE along with watering, redness and photophobia due to chemical - injury(lime-burn) while playing 2 weeks ago.On examination Visual acuity was finger counting 3 metres,360 degree limbal-ischaemia, total macular corneal - haze and anterior-chamber details not visible.Under GA conjunctival limbal autograft was harvested from RE of 1mm by 3.5mm from superior-limbus.360 degree conj. peritomy was done upto 2-3 mm from limbus and pannus gently removed protecting the stromal-bed.Freshly harvested AMG from uncomplicated LSCS was placed over corneal and scleral bed with basement - membrane side up with the help of fibrin-glue.Then timbal-autograft was divided into 8-10 pieces and placed over AMG in mid-peripheral area in a circular pattern with the help of glue and bandage contact lens was placed.After 3 months vision improved to 6/24(0.40 logMAR).

Conclusions/Take Home Message:

So SLET is a reproducible, single stage technique for effective management of LSCD. Transplant of autologous conj. limbal autograft is responsible for corneal epithelial renewal and regeneration . Stem cell graft acts as a barrier, preventing conjunctival epithelium from growing onto the cornea. Also as it is an autologous transplant so no immunosuppression treatment is required. SLET is very cost effective for not only higher tertiary centres but equally beneficial for small & developing Ophthalmic Centres with minimum requirement of higher - end equipments and infrastructure.