Limbal graft transplantation: a rare implementation in pediatric limbal stem cell deficiency.
Humans
Limbus Corneae
/ cytology
Child
Male
Female
Adolescent
Child, Preschool
Corneal Diseases
/ surgery
Retrospective Studies
Follow-Up Studies
Visual Acuity
Stem Cell Transplantation
/ methods
Stem Cells
/ cytology
Eye Burns
/ surgery
Burns, Chemical
/ surgery
Corneal Transplantation
/ methods
Transplantation, Autologous
Treatment Outcome
Limbal Stem Cell Deficiency
Limbal graft transplantation
Limbal stem cell deficiency
Ocular chemical injury
Pediatric patients
Surgical success rate
Journal
International ophthalmology
ISSN: 1573-2630
Titre abrégé: Int Ophthalmol
Pays: Netherlands
ID NLM: 7904294
Informations de publication
Date de publication:
02 Aug 2024
02 Aug 2024
Historique:
received:
24
02
2024
accepted:
29
07
2024
medline:
2
8
2024
pubmed:
2
8
2024
entrez:
2
8
2024
Statut:
epublish
Résumé
To evaluate limbal graft transplantation success in pediatric patients with chemical injury-induced limbal stem cell deficiency (LSCD) using the 'LSCD Working Group' staging system. Medical records of 11 eyes of 11 children who underwent limbal graft transplantation (limbal autograft/limbal allograft) were included. Surgical success was defined as improvement in the post-operative 1st year LSCD stage. The mean age was 12 ± 5 (4-17) years. Causative agent was alkaline in 4(36.4%) and acid in 3(27.2%) patients. Limbal autograft was performed in 9 (81.8%) eyes with unilateral LSCD, and allograft transplantation was performed in 2 (18.2%) eyes with bilateral LSCD. The mean follow-up time was 33.89 ± 30.73 (12-102.33) months. The overall limbal graft transplantation success rate was 72.7%. Among 9 patients who receive limbal autograft, 8 had improvement in post-operative LSCD stage, 1 had stable LSCD stage. Of the 2 patients who receive limbal allograft, post-operative LSCD stage remained the same in 1 and worsened in 1 patient. The mean time between injury and the surgery was 30.47 ± 30.08 (7-108.47) months. Penetrating keratoplasty was performed in 3 (27.2%) of 11 patients following limbal graft transplantation. Management of LSCD in children is challenging and appears to be somewhat different from that of adults. Limited data in the literature indicate that cultivated or simple limbal epithelial transplantations (CLET/SLET) are primarily preferred in children. Although the tendency to take small tissue from the healthy eye is noteworthy, conventional limbal allograft and autograft transplantations also show promising results without any further complications in at least 1 year follow-up period.
Identifiants
pubmed: 39093517
doi: 10.1007/s10792-024-03269-5
pii: 10.1007/s10792-024-03269-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
337Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer Nature B.V.
Références
Sridhar MS (2018) Anatomy of cornea and ocular surface. Indian J Ophthalmol 66:190–194. https://doi.org/10.4103/ijo.IJO_646_17
doi: 10.4103/ijo.IJO_646_17
pubmed: 29380756
pmcid: 5819093
Altshuler A, Amitai-Lange A, Tarazi N, Dey S, Strinkovsky L, Hadad-Porat S et al (2021) Discrete limbal epithelial stem cell populations mediate corneal homeostasis and wound healing. Cell Stem Cell 28:1248-1261.e8. https://doi.org/10.1016/j.stem.2021.04.003
doi: 10.1016/j.stem.2021.04.003
pubmed: 33984282
pmcid: 8254798
Dua HS, Azuara-Blanco A (2000) Limbal stem cells of the corneal epithelium. Surv Ophthalmol 44:415–425. https://doi.org/10.1016/s0039-6257(00)00109-0
doi: 10.1016/s0039-6257(00)00109-0
pubmed: 10734241
Furundaoturan O, Palamar M, Barut Selver O (2023) Precision of limbal ischemia evaluation in ocular chemical injuries with anterior segment optical coherence tomography angiography. Graefe’s Arch Clin Exp Ophthalmol 261:155–159. https://doi.org/10.1007/s00417-022-05735-1
doi: 10.1007/s00417-022-05735-1
Dua HS, Saini JS, Azuara-Blanco A, Gupta P (2000) Limbal stem cell deficiency: concept, aetiology, clinical presentation, diagnosis and management. Indian J Ophthalmol 48:83–92
pubmed: 11116520
Lal I, Gupta N, Purushotham J, Sangwan V (2016) Limbal stem cell deficiency: current management. J Clin Ophthalmol Res 4:3–12
doi: 10.4103/2320-3897.174344
Liang L, Sheha H, Li J, Tseng SCG (2009) Limbal stem cell transplantation: new progresses and challenges. Eye (Lond) 23:1946–1953. https://doi.org/10.1038/eye.2008.379
doi: 10.1038/eye.2008.379
pubmed: 19098704
Le Q, Chauhan T, Yung M, Tseng C-H, Deng SX (2020) Outcomes of limbal stem cell transplant: a meta-analysis. JAMA Ophthalmol 138:660–670. https://doi.org/10.1001/jamaophthalmol.2020.1120
doi: 10.1001/jamaophthalmol.2020.1120
pubmed: 32324211
Ozer MD, Altinkurt E, Alparslan N (2020) The long-term surgical outcomes of conjunctival-limbal autograft procedure with or without penetrating keratoplasty in eyes with unilateral limbal stem cell deficiency. Taiwan J Ophthalmol 10:22–28. https://doi.org/10.4103/tjo.tjo_55_19
doi: 10.4103/tjo.tjo_55_19
pubmed: 32309120
pmcid: 7158933
Serna-Ojeda JC, Basu S, Vazirani J, Garfias Y, Sangwan VS (2020) Systemic immunosuppression for limbal allograft and allogenic limbal epithelial cell transplantation. Med Hypothesis, Discov Innov Ophthalmol J 9:23–32
Cheng J, Zhai H, Wang J, Duan H, Zhou Q (2017) Long-term outcome of allogeneic cultivated limbal epithelial transplantation for symblepharon caused by severe ocular burns. BMC Ophthalmol 17:8. https://doi.org/10.1186/s12886-017-0403-9
doi: 10.1186/s12886-017-0403-9
pubmed: 28143466
pmcid: 5282665
Sangwan VS, Basu S, MacNeil S, Balasubramanian D (2012) Simple limbal epithelial transplantation (SLET): a novel surgical technique for the treatment of unilateral limbal stem cell deficiency. Br J Ophthalmol 96:931–934. https://doi.org/10.1136/bjophthalmol-2011-301164
doi: 10.1136/bjophthalmol-2011-301164
pubmed: 22328817
Sacchetti M, Rama P, Bruscolini A (2018) Lambiase A (2018) limbal stem cell transplantation: clinical results, limits, and perspectives. Stem Cells Int 1:8086269. https://doi.org/10.1155/2018/8086269
doi: 10.1155/2018/8086269
Shanbhag SS, Nikpoor N, Rao Donthineni P, Singh V, Chodosh J, Basu S (2020) Autologous limbal stem cell transplantation: a systematic review of clinical outcomes with different surgical techniques. Br J Ophthalmol 104:247–253. https://doi.org/10.1136/bjophthalmol-2019-314081
doi: 10.1136/bjophthalmol-2019-314081
pubmed: 31118185
Shimazaki J, Shimmura S, Tsubota K (2004) Donor source affects the outcome of ocular surface reconstruction in chemical or thermal burns of the cornea. Ophthalmology 111:38–44. https://doi.org/10.1016/j.ophtha.2003.02.003
doi: 10.1016/j.ophtha.2003.02.003
pubmed: 14711712
Baylis O, Figueiredo F, Henein C, Lako M, Ahmad S (2011) 13 years of cultured limbal epithelial cell therapy: a review of the outcomes. J Cell Biochem 112:993–1002. https://doi.org/10.1002/jcb.23028
doi: 10.1002/jcb.23028
pubmed: 21308743
Dua HS, King AJ, Joseph A (2001) A new classification of ocular surface burns. Br J Ophthalmol 85:1379–1383. https://doi.org/10.1136/bjo.85.11.1379
doi: 10.1136/bjo.85.11.1379
pubmed: 11673310
pmcid: 1723789
Kheirkhah A, Blanco G, Casas V, Hayashida Y, Raju VK, Tseng SCG (2008) Surgical strategies for fornix reconstruction based on symblepharon severity. Am J Ophthalmol 146:266-275.e4. https://doi.org/10.1016/j.ajo.2008.03.028
doi: 10.1016/j.ajo.2008.03.028
pubmed: 18514608
Deng SX, Borderie V, Chan CC, Dana R, Figueiredo FC, Gomes JAP et al (2019) Global consensus on definition, classification, diagnosis, and staging of limbal stem cell deficiency. Cornea 38:364–375. https://doi.org/10.1097/ICO.0000000000001820
doi: 10.1097/ICO.0000000000001820
pubmed: 30614902
pmcid: 6363877
Sacchetti M, Lambiase A, Cortes M, Sgrulletta R, Bonini S, Merlo D et al (2005) Clinical and cytological findings in limbal stem cell deficiency. Graefes Arch Clin Exp Ophthalmol 243:870–876. https://doi.org/10.1007/s00417-005-1159-0
doi: 10.1007/s00417-005-1159-0
pubmed: 15778841
Vajpayee RB, Shekhar H, Sharma N, Jhanji V (2014) Demographic and clinical profile of ocular chemical injuries in the pediatric age group. Ophthalmology 121:377–380. https://doi.org/10.1016/j.ophtha.2013.06.044
doi: 10.1016/j.ophtha.2013.06.044
pubmed: 23948464
Sejpal K, Ali MH, Maddileti S, Basu S, Ramappa M, Kekunnaya R et al (2013) Cultivated limbal epithelial transplantation in children with ocular surface burns. JAMA Ophthalmol 131:731–736. https://doi.org/10.1001/jamaophthalmol.2013.2308
doi: 10.1001/jamaophthalmol.2013.2308
pubmed: 23559315
Cheung AY, Sarnicola E, Eslani M, Wright E, Goebel J, Hooper DK et al (2021) Clinical outcomes of allogeneic ocular surface stem cell transplantation in pediatric patients. Cornea 40:54–60. https://doi.org/10.1097/ICO.0000000000002379
doi: 10.1097/ICO.0000000000002379
pubmed: 32501833
Ozdemir O, Tekeli O, Ornek K, Arslanpençe A, Yalçindağ NF (2004) Limbal autograft and allograft transplantations in patients with corneal burns. Eye (Lond) 18:241–248. https://doi.org/10.1038/sj.eye.6700640
doi: 10.1038/sj.eye.6700640
pubmed: 15004571
Dua HS, Azuara-Blanco A (1999) Allo-limbal transplantation in patients with limbal stem cell deficiency. Br J Ophthalmol 83:414–419. https://doi.org/10.1136/bjo.83.4.414
doi: 10.1136/bjo.83.4.414
pubmed: 10434862
pmcid: 1722986
Haagdorens M, Van Acker SI, Van Gerwen V, Ní Dhubhghaill S, Koppen C, Tassignon M-J et al (2016) Limbal stem cell deficiency: current treatment options and emerging therapies. Stem Cells Int 2016:9798374. https://doi.org/10.1155/2016/9798374
doi: 10.1155/2016/9798374
pubmed: 26788074
Mittal V, Jain R, Mittal R, Vashist U, Narang P (2016) Successful management of severe unilateral chemical burns in children using simple limbal epithelial transplantation (SLET). Br J Ophthalmol 100:1102–1108. https://doi.org/10.1136/bjophthalmol-2015-307179
doi: 10.1136/bjophthalmol-2015-307179
pubmed: 26701687
Unlu BH, Utine CA, Durak I (2021) Simple limbal epithelial transplantation in limbal stem cell deficiency after chemical eye injury. Eur Eye Res 1:47–52. https://doi.org/10.14744/eer.2021.81300
doi: 10.14744/eer.2021.81300
Pannu A, Sati A, Mishra SK, Kumar S, Dhar S (2021) Innovative technique of mini-simple limbal epithelial transplantation in pediatric patients. Indian J Ophthalmol 69:2222–2224
doi: 10.4103/ijo.IJO_2834_20
pubmed: 34304214
pmcid: 8482941
Fatima A, Iftekhar G, Sangwan VS, Vemuganti GK (2008) Ocular surface changes in limbal stem cell deficiency caused by chemical injury: a histologic study of excised pannus from recipients of cultured corneal epithelium. Eye (Lond) 22:1161–1167. https://doi.org/10.1038/sj.eye.6702895
doi: 10.1038/sj.eye.6702895
pubmed: 17558385
Choi SH, Kim MK, Oh JY (2019) Corneal limbal stem cell deficiency in children with Stevens-Johnson syndrome. Am J Ophthalmol 199:1–8. https://doi.org/10.1016/j.ajo.2018.10.016
doi: 10.1016/j.ajo.2018.10.016
pubmed: 30347185
Le Q, Xu J, Deng SX (2018) The diagnosis of limbal stem cell deficiency. Ocul Surf 16:58–69. https://doi.org/10.1016/j.jtos.2017.11.002
doi: 10.1016/j.jtos.2017.11.002
pubmed: 29113917
Korkmaz I, Palamar M, Egrilmez S, Gurdal M, Yagci A (2023) Evaluation of limbal stem cell transplant success in ocular chemical injury. Exp Clin Transplant 21:684–690. https://doi.org/10.6002/ect.2021.0393
doi: 10.6002/ect.2021.0393
pubmed: 34981716
Wylegala E, Dobrowolski D, Tarnawska D, Janiszewska D, Gabryel B, Malecki A et al (2008) Limbal stem cells transplantation in the reconstruction of the ocular surface: 6 years experience. Eur J Ophthalmol 18:886–890. https://doi.org/10.1177/112067210801800605
doi: 10.1177/112067210801800605
pubmed: 18988157
Deng SX, Kruse F, Gomes JAP, Chan CC, Daya S, Dana R et al (2020) Global consensus on the management of limbal stem cell deficiency. Cornea 39:1291–1302. https://doi.org/10.1097/ICO.0000000000002358
doi: 10.1097/ICO.0000000000002358
pubmed: 32639314
Shanbhag SS, Chanda S, Donthineni PR, Basu S (2021) Surgical management of unilateral partial limbal stem cell deficiency: conjunctival autografts versus simple limbal epithelial transplantation. Clin Ophthalmol 15:4389–4397. https://doi.org/10.2147/OPTH.S338894
doi: 10.2147/OPTH.S338894
pubmed: 34785885
pmcid: 8590448
El-Hofi AH, Helaly HA (2019) Evaluation of limbal transplantation in eyes with bilateral severe ocular surface damage secondary to chemical injury. Clin Ophthalmol 13:383–390
doi: 10.2147/OPTH.S192316
pubmed: 30858688
pmcid: 6387598
Kasikci M, Korkmaz I, Palamar M, Egrilmez S, Yagci A, Barut Selver O (2022) Evaluation of the factors that influence surgical outcome in conjunctival-limbal allograft transplantation. Eye (Lond) 37(11):2192–2196. https://doi.org/10.1038/s41433-022-02314-w
doi: 10.1038/s41433-022-02314-w
pubmed: 36418907