Cornea Cases

Title:

A case of multistep ocular surface reconstruction after severe unilateral chemical burn

Case Report Details

First Author: S.Kalinnikova RUSSIA

Co Author(s):    B. Malyugin   M. Zakharova   S. Borzenok   M. Gerasimov   M. Kataev        

Abstract Details

Purpose:

To describe a patient's clinical course with total symblepharon and total limbal stem cell deficiency following severe unilateral ocular surface burn treated by step-by-step fornix reconstruction and glueless simple limbal epithelium transplantation.

Setting:

The S. Fyodorov Eye Microsurgery Federal State Institution, The A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Report of case or case series:

A 55-year-old woman was presented in the clinic with total symblepharon, and total limbal stem cell deficiency (LSCD) on OD as late complications after accidental household ocular burn with a gel bath-room cleaner in 2016. BCVA in OD decreased to 0,02 (decimal values) from the normal VA that she has had throughout life. By the first appointment in February 2017, the patient was complaining about the absence of the subject vision and fusion of the eyelids on OD. No serious eye and systemic comorbidities were found. In the first stage, she was referred to the oculoplastic department for step-by-step fornix reconstruction. First intervention in March 2017 included primary establishing of the fornices by lip oral mucosa grafting (two full-thickness and two split-grafts), with temporary blepharorrhaphy. The cornea was covered with remained conjunctival tissue. The second and third intervention was performed to eliminate lower and upper eyelids' entropion in January and April 2018, respectively. After that, the reestablished fornices' depth were considered appropriate for a corneal epithelium reconstruction, and the patient was scheduled for glueless simple limbal epithelium transplantation (G-SLET). Preoperative BCVA was proectio lucis certa for OD and 0,7 for OS. Early and late postoperative periods were uneventful. BCVA for OD gradually improved from counting fingers at two months after the G-SLET to 0,01 in January 2019. Small conjunctival synechiae were noted in the lower fornix OD. At one appointment, the patient accidentally touched the cornea OD with an eye drops tip, and the resulted erosion was successfully managed with an antiseptic and dexpanthenol gel application. At the last appointment, the cornea OD was entirely covered with semitransparent epithelium; however, deep- and superficial neovascular vessels were noted. The iris structure and immature cataract were visible. On the OS, a small scar was seen under the upper limbus.

Conclusions/Take Home Message:

Ocular surface reconstruction after severe chemical burns is a challenging and unique situation in most cases. The latest research uncovered preliminary surgical tactics where symblepharon release, corneal reepithelization, and optical keratoplasty are better to be done step-by-step with an appropriate time window. According to this manner, we were able to achieve anatomical and visual success. G-SLET is a new surgical technique that is promising for wide application in unilateral LSCD.