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Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports

INTRODUCTION AND IMPORTANCE: This report describes a new technique of deep anterior lamellar limbo-keratoplasty for the management of bilateral limbal stem cell deficiency (LSCD) with corneal scarring. PRESENTATION OF CASES: A 45-year-old male presented with chronic sequelae of ocular chemical injur...

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Autores principales: Jain, Neha, Kate, Anahita, Basu, Sayan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403099/
https://www.ncbi.nlm.nih.gov/pubmed/35863285
http://dx.doi.org/10.1016/j.ijscr.2022.107409
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author Jain, Neha
Kate, Anahita
Basu, Sayan
author_facet Jain, Neha
Kate, Anahita
Basu, Sayan
author_sort Jain, Neha
collection PubMed
description INTRODUCTION AND IMPORTANCE: This report describes a new technique of deep anterior lamellar limbo-keratoplasty for the management of bilateral limbal stem cell deficiency (LSCD) with corneal scarring. PRESENTATION OF CASES: A 45-year-old male presented with chronic sequelae of ocular chemical injury and had bilateral total LSCD with corneal scarring. The visual acuity (VA) in the right eye was counting fingers. A large diameter deep anterior lamellar limbo-keratoplasty (DAL-LK) was carried out and the donor cornea and limbus were sourced from a single tissue. The VA at the last visit, 2.5 years after the surgery was 20/80. A similar presentation was seen in a 31-year-old male with a VA of 20/320 in the right eye. He underwent a DAL-LK and 3 years after the procedure, the VA was 20/60. Both grafts remained clear with no episodes of rejection until the last follow up visit. DISCUSSION: Limbal stem cell transplantation with keratoplasty or a keratoprosthesis is required to manage bilateral LSCD with stromal scarring. The former necessitates multiple interventions while the latter is associated with several globe threatening complications. DAL-LK was devised to overcome these disadvantages and offers a simple, single staged technique of simultaneously transplanting the corneal stroma with the limbal stem cells. As the host endothelium is preserved, there is no risk of rejection episodes. CONCLUSION: DAL-LK can successfully restore stability of the ocular surface and visually rehabilitate cases with bilateral LSCD and stromal scarring. The procedure has stable long-term outcomes with a good safety profile.
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spelling pubmed-94030992022-08-26 Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports Jain, Neha Kate, Anahita Basu, Sayan Int J Surg Case Rep Case Report INTRODUCTION AND IMPORTANCE: This report describes a new technique of deep anterior lamellar limbo-keratoplasty for the management of bilateral limbal stem cell deficiency (LSCD) with corneal scarring. PRESENTATION OF CASES: A 45-year-old male presented with chronic sequelae of ocular chemical injury and had bilateral total LSCD with corneal scarring. The visual acuity (VA) in the right eye was counting fingers. A large diameter deep anterior lamellar limbo-keratoplasty (DAL-LK) was carried out and the donor cornea and limbus were sourced from a single tissue. The VA at the last visit, 2.5 years after the surgery was 20/80. A similar presentation was seen in a 31-year-old male with a VA of 20/320 in the right eye. He underwent a DAL-LK and 3 years after the procedure, the VA was 20/60. Both grafts remained clear with no episodes of rejection until the last follow up visit. DISCUSSION: Limbal stem cell transplantation with keratoplasty or a keratoprosthesis is required to manage bilateral LSCD with stromal scarring. The former necessitates multiple interventions while the latter is associated with several globe threatening complications. DAL-LK was devised to overcome these disadvantages and offers a simple, single staged technique of simultaneously transplanting the corneal stroma with the limbal stem cells. As the host endothelium is preserved, there is no risk of rejection episodes. CONCLUSION: DAL-LK can successfully restore stability of the ocular surface and visually rehabilitate cases with bilateral LSCD and stromal scarring. The procedure has stable long-term outcomes with a good safety profile. Elsevier 2022-07-14 /pmc/articles/PMC9403099/ /pubmed/35863285 http://dx.doi.org/10.1016/j.ijscr.2022.107409 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Jain, Neha
Kate, Anahita
Basu, Sayan
Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports
title Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports
title_full Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports
title_fullStr Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports
title_full_unstemmed Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports
title_short Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports
title_sort deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: two case reports
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403099/
https://www.ncbi.nlm.nih.gov/pubmed/35863285
http://dx.doi.org/10.1016/j.ijscr.2022.107409
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