Abstract
Purpose
To describe the outcome of simple limbal epithelial transplantation along with Phacoemulsification and IOL implantation for visual rehabilitation in limbal stem cell deficiency due to ocular surface squamous neoplasia.
Observations
This case report of a 66-year-old woman clinically diagnosed with OSSN in her right eye involving all cornea and limbus meridians. Topical chemotherapy for tumor treatment was done, followed by SLET and sequential cataract surgery. The entire tumor could be clinically reduced with topical chemotherapy but a LSCD could not be avoided. After SLET, corneal transparency was restored, and anterior segment details could be seen, phacoemulsification was performed uneventfully. After a follow-up period of 18 months, stable ocular surface and visual acuity and no tumor recurrence was observed.
Conclusions
SLET is an option to restore not only corneal epithelium homeostasis but also gain cornea transparency, avoid keratoplasties and allow anterior segment surgeries to be performed.
Importance
This case report provide evidence of benefits of simple limbal epithelial transplantation in ocular surface squamous neoplasia and shows that cataract surgery could be performed uneventfully after limbal stem cell transplantation.
1
Introduction
Limbal stem cell deficiency (LSCD) is characterized by conjunctival epithelial ingrowth, persistent epithelial defects and or chronic epithelial staining leading to destruction of the basal membrane and superficial fibrovascular tissue ingrowth with functional impairment due to loss of transparency and/or integrity of the cornea. In 2012 Sangwan et al. proposed a novel technique they named simple limbal epithelial transplantation (SLET) for the treatment of unilateral LSCD. Limbal stem cell deficiency can be a cause of irregularities in the cornea in turn making it difficult to calculate the power of and intra-ocular lens. We present a case of visual rehabilitation in OSSN after SLET and phacoemulsificacion.
2
Case report
A 66- year-old female presented with a large corneal-conjunctival lesion in her right eye causing progressive vision loss for the past 12 months. At initial evaluation, she had a visual acuity (VA) of hand movement (HM), and an intraocular pressure of 16 mmhg in her right eye, and a VA of 20/40 and 14 mmhg in her left eye. Slit-lamp examination of the right eye is shown in Fig. 1 A. Biomicroscopy in her left eye only revealed a NO2NC2 cataract (according to Lens Opacities Classification System III). Due to clinical presentation the diagnosis of OSSN was made. The patient was administered 5-Fluorouracil 1 % (5-FU) 4 times daily every two weeks (two weeks on treatment and two week off treatment), this regimen was repeated 5 times until complete clinical regression ( Fig. 1 B and C).
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