Autologous Limbal Stem Cell Transplantation for Severe Ocular Surface Chemical Burn
J.L. Laus; B.C. Martins; E.F. Rodrigues Filho; A.G.R. Melo
College of Agricultural and Veterinarian Sciences, Sao Paulo State University, Jaboticabal, Sao Paulo, Brazil
This paper reports the reconstruction of damaged ocular surface due to chemical burn using autologous limbal transplantation. A 11-monthsold male Bull Terrier was presented for ophthalmic evaluation with a 1-week history of chemical burn (chlorhexidine, miconazole and glycerin shampoo) in the right eye. Ocular findings included severe corneal edema and vascularization, granulation tissue over peripheral cornea and sclera and superficial corneal ulceration. Mucopurulent ocular discharge and blepharospasm were noticed. Anterior chamber could not be observed due to corneal opacification. Regardless dazzle reflex was present, menace response was absent. The left eye exhibited no abnormality. The patient underwent autologous limbal transplantation surgery. The donor tissues were harvested from the left eye by superficial lamellar dissection and consisted of two corneal-limbal-conjunctival explants, at 11-1 o'clock and 5-7 o'clock, consisting of peripheral cornea, limbus and bulbar conjunctiva. The granulation tissue on the recipient eye was excised as well as the abnormal corneal epithelium by superficial keratotomy. Two recipient beds were prepared, by incising the cornea, limbus and conjunctiva, on areas corresponding to 7-9 o'clock and 11-1 o'clock. The grafts were transferred to recipient beds and interrupted 9-0 nylon sutures were placed. Topical tobramycin, xenogenous blood serum and sodium chloride 5% were used four times daily for two weeks. Also, meloxicam 0.1mg/kg was given orally every 24 hours, for seven days. Medications frequency was adjusted as determined by the case resolution, except the sodium chloride. The patient was examined every week during 2 months following surgery. Grafts remained in place during all postoperative period. Ocular discharge and blepharospasm were absent one week after surgery. Ulcer healed after 15 days and corneal scarring and vessels were observed instead. Corneal edema remained severe for five weeks and pupil could be observed after 42 days. Two months postoperatively, the patient exhibited mild corneal edema, few blood vessels, positive menace response along with a visible anterior chamber though the cornea. The donor eye healed in one week. Chemical burns are challenging for maintaining the ocular surface integrity and limbal stems cells are recognized to play a vital role in corneal cell renewal. Limbal autologous transplantation was effective in restoring corneal integrity and diminishing its opacity, inducing minimal damage to the donor eye.