Long-term Outcome of Limbal Stem Cell Transplantation for Management of Total Limbal Stem Cell Deficiency due to Chemical Burn
Journal of Ophthalmic and Optometric Sciences,
Vol. 1 No. 4 (2017),
24 Tir 2017
,
Page 40-48
https://doi.org/10.22037/joos.v1i4.25081
Abstract
Purpose: To evaluate the long-term outcome of limbal stem cell transplantation for management of total limbal stem cell deficiency due to chemical burn.
Patients and Methods: In this retrospective cross sectional study; records of patients with history of severe (grade III to IV) chemical burns who underwent limbal stem cell transplantation in Labbafinejad Medical Center, Tehran, Iran between 2006 and 2016 were reviewed and data including demographic characteristics, visual acuity, surgical interventions and outcomes were reported.
Results: Fifty eyes of fifty patients with a history of conjunctival limbal autograft (N = 24) or keratolimbal allograft (N = 26) with at least 12-months follow-up were included. The overall 1-year and 5-year survival was 100 % and 84.1 % for conjunctival limbal autograft and 80.4 % and 40 % for keratolimbal allograft, respectively (P = 0.037). Corneal transplantation was performed after limbal stem cell transplantation in 20 eyes after conjunctival limbal autograft and 25 eyes after keratolimbal allograft. The 1-year and 5-year corneal graft survival was 93.3 % and 63.8 % after conjunctival limbal autograft and 92 % and 38.4 % after keratolimbal allograft (P = 0.005 for five year survival). There was a significant improvement in LogMAR BCVA (1.79 versus 2.17, P < 0.001) in all patients with no statistically significant difference between the two groups.
Conclusion: Severe chemical burn is associated with significant ocular morbidity and long-term prognosis is poor. Graft survival rate was significantly better in conjunctival limbal autograft compared to keratolimbal allograft when comparing the Long-term outcome of limbal stem cell transplantation for management of total limbal stem cell deficiency due to chemical burn.
Keywords: Limbus Cornea, Stem Cell, Transplantation, Cornea, Eye Burns
How to Cite
References
Ghosh S, Salvador-Culla B, Kotagiri A, Pushpoth S, Tey A, Johnson ZK, et al. Acute Chemical Eye Injury and Limbal Stem Cell Deficiency-A Prospective Study in the United Kingdom. Cornea. 2019;38(1):8-12.
Vazirani J, Nair D, Shanbhag S, Wurity S, Ranjan A, Sangwan V. Limbal Stem Cell Deficiency-Demography and Underlying Causes. Am J Ophthalmol. 2018;188:99-103.
Baradaran-Rafii A, Eslani M, Haq Z, Shirzadeh E, Huvard MJ, Djalilian AR. Current and Upcoming Therapies for Ocular Surface Chemical Injuries.Ocul Surf. 2017 Jan;15(1):48-64.
Yazdanpanah G, Jabbehdari S, Djalilian AR. Limbal and corneal epithelial homeostasis. Curr Opin Ophthalmol. 2017;28(4):348-54.
Holland EJ. Epithelial transplantation for the management of severe ocular surface disease. Trans Am Ophthalmol Soc. 1996;94:677-743.
Baradaran-Rafii A, Delfazayebaher S, Aghdami N, Taghiabadi E3, Bamdad S, Roshandel D. Midterm outcomes of penetrating keratoplasty after cultivated oral mucosal epithelialtransplantation in chemical burn. Ocul Surf. 2017;15(4):789-94.
Borderie VM, Levy O, Georgeon C, Bouheraoua N. Simultaneous penetrating keratoplasty and amniotic membrane transplantation in eyes with a history of limbal stem cell deficiency. J Fr Ophtalmol. 2018;41(7):583-91.
Ştefan C, Timaru CM, Iliescu DA, Schmitzer S, De Algerino S, Batras M, Glaucoma after chemical burns and radiation. Rom J Ophthalmol. 2016;60(4):209-15.
Bunker DJ, George RJ, Kleinschmidt A, Kumar RJ, Maitz P. Alkali-related ocular burns: a case series and review. J Burn Care Res. 2014;35(3):261-8.
Baradaran-Rafii A, Eslani M, Djalillian AR. Complications of keratolimbal allograft surgery. Cornea. 2013;32(5):561-6.
Santos MS1, Gomes JA, Hofling-Lima AL, Rizzo LV, Romano AC, Belfort R Jr. Survival analysis of conjunctival limbal grafts and amniotic membrane transplantation in eyeswith total limbal stem cell deficiency. Am J Ophthalmol. 2005;140(2):223-30.
Solomon A, Ellies P, Anderson DF, Touhami A, Grueterich M, Espana EM, et al. Long-term outcome of keratolimbal allograft with or without penetrating keratoplasty for totallimbal stem cell deficiency. Ophthalmology. 2002;109(6):1159-66.
Tsai RJ1, Tseng SC. Human allograft limbal transplantation for corneal surface reconstruction.Cornea. 1994;13(5):389-400.
Tsubota K1, Toda I, Saito H, Shinozaki N, Shimazaki J. Reconstruction of the corneal epithelium by limbal allograft transplantation for severe ocular surface disorders. Ophthalmology. 1995;102(10):1486-96.
Tan DT, Ficker LA, Buckley RJ. Limbal transplantation. Ophthalmology. 1996 ;103(1):29-36.
Tsubota K, Satake Y, Kaido M, Shinozaki N, Shimmura S, Bissen-Miyajima H, et al. Treatment of severe ocular-surface disorders with corneal epithelial stem-cell transplantation.N Engl J Med. 1999 3;340(22):1697-703.
Shimazaki J, Shimmura S, Fujishima H, Tsubota K. Association of preoperative tear function with surgical outcome in severe Stevens-Johnson syndrome. Ophthalmology. 2000;107(8):1518-23.
Ilari L, Daya SM. Long-term outcomes of keratolimbal allograft for the treatment of severe ocular surfacedisorders. Ophthalmology. 2002;109(7):1278-84.
Cauchi PA, Ang GS, Azuara-Blanco A, Burr JM. A systematic literature review of surgical interventions for limbal stem cell deficiency in humans. Am J Ophthalmol. 2008;146(2):251-9.
Barreiro TP, Santos MS, Vieira AC, de Nadai Barros J, Hazarbassanov RM, Gomes JÁ. Comparative study of conjunctival limbal transplantation not associated with the use of amniotic membrane transplantation for treatment of total limbal deficiency secondary to chemical injury. Cornea. 2014l;33(7):716-20.
Miri A, Al-Deiri B, Dua HS. Long-term outcomes of autolimbal and allolimbal transplants.Ophthalmology. 2010;117(6):1207-13.
Meallet MA, Espana EM, Grueterich M, Ti SE, Goto E, Tseng SC. Amniotic membrane transplantation with conjunctival limbal autograft for total limbal stem celldeficiency. Ophthalmology. 2003;110(8):1585-92.
Daya SM. Conjunctival-limbal autograft. Curr Opin Ophthalmol. 2017;28(4):370-6.
Jenkins C, Tuft S, Liu C, Buckley R. Limbal transplantation in the management of chronic contact-lens-associated epitheliopathy. Eye (Lond). 1993;7 ( Pt 5):629-33.
Wylegala E, Dobrowolski D, Tarnawska D, Janiszewska D, Gabryel B, Malecki A, Limbal stem cells transplantation in the reconstruction of the ocular surface: 6 years experience. Eur J Ophthalmol. 2008;18(6):886-90.
Theng JT, Tan DT. Combined penetrating keratoplasty and limbal allograft transplantation for severe corneal burns. Ophthalmic Surg Lasers. 1997;28(9):765-8.
Sepsakos L, Cheung AY, Holland EJ. Outcomes of Keratoplasty After Ocular Surface Stem Cell Transplantation.Cornea. 2017;36(9):1025-30.
- Abstract Viewed: 137 times
- PDF Downloaded: 91 times